Provider Demographics
NPI:1356598239
Name:BURGHER, KRISTIN JANEICE (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANEICE
Last Name:BURGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21810 WILLAMETTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3256
Mailing Address - Country:US
Mailing Address - Phone:503-994-4353
Mailing Address - Fax:833-975-0942
Practice Address - Street 1:21810 WILLAMETTE DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3256
Practice Address - Country:US
Practice Address - Phone:503-994-4353
Practice Address - Fax:833-975-0942
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD151233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine