Provider Demographics
NPI:1780816942
Name:BURGAN, JOHN TODD (DPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TODD
Last Name:BURGAN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 ROUND HILL LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4491
Mailing Address - Country:US
Mailing Address - Phone:865-588-8017
Mailing Address - Fax:
Practice Address - Street 1:4918 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5199
Practice Address - Country:US
Practice Address - Phone:865-588-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist