Provider Demographics
NPI:1629276308
Name:BERDAN, JEFFERY THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:THOMAS
Last Name:BERDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 5TH ST SE STE 4200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4604
Mailing Address - Country:US
Mailing Address - Phone:253-459-7000
Mailing Address - Fax:
Practice Address - Street 1:1450 5TH ST SE STE 4200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4604
Practice Address - Country:US
Practice Address - Phone:253-459-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017911208100000X
UT7651257-1204208100000X
WAOP60570179208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation