MEDICARE: DR. MATTHEW TYRRELL BURRUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	R2822	TX
2	207X00000X	Orthopaedic Surgery Physician	R2822	TX

General Provider Information

NPI Number	:	1538458526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW TYRRELL BURRUS M.D.

Provider Business Mailing Address
First Line	:	1015 E 32ND ST STE 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2700
Country	:	US
Telephone Number	:	512-477-6341
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 E 32ND ST STE 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2700
Country	:	US
Telephone Number	:	512-477-6341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	03/17/2018

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