Provider Demographics
NPI:1669530879
Name:BURDETTE, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7700 HIGHWAY 69 S STE C
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8784
Mailing Address - Country:US
Mailing Address - Phone:205-349-1040
Mailing Address - Fax:205-349-4010
Practice Address - Street 1:7700 HIGHWAY 69 S
Practice Address - Street 2:SUITE C
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8783
Practice Address - Country:US
Practice Address - Phone:205-349-1040
Practice Address - Fax:205-349-4010
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine