Provider Demographics
NPI:1053541565
Name:BURGIN, JODE JANN (MD)
Entity type:Individual
Prefix:DR
First Name:JODE JANN
Middle Name:
Last Name:BURGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:9220 ELLERBE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6739
Practice Address - Country:US
Practice Address - Phone:318-681-5282
Practice Address - Fax:318-681-5284
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301095167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2398521Medicaid
LA431781YJBAMedicare PIN