Provider Demographics
NPI:1174870174
Name:BURGOON, EMILY JANE (DO)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
Last Name:BURGOON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CASTLE ROCK RD 2A
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8806
Mailing Address - Country:US
Mailing Address - Phone:540-798-5655
Mailing Address - Fax:928-852-0041
Practice Address - Street 1:45 CASTLE ROCK RD 2A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8806
Practice Address - Country:US
Practice Address - Phone:540-798-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021895204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM