Provider Demographics
NPI:1609285055
Name:BURGGREN, BLAIR MICHAEL (DVM)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:MICHAEL
Last Name:BURGGREN
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 PACIFIC AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2002
Mailing Address - Country:US
Mailing Address - Phone:360-455-5155
Mailing Address - Fax:360-742-3028
Practice Address - Street 1:3011 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2002
Practice Address - Country:US
Practice Address - Phone:360-455-5155
Practice Address - Fax:360-742-3028
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT00007346174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian