Healthcare Provider Details

I. General information

NPI: 1780800664
Provider Name (Legal Business Name): BURTON W SCHWARTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STADIUM DRIVE BROWN LUPTON HEALTH CENTER TCU
FT WORTH TX
76109
US

IV. Provider business mailing address

TCU PO BOX 297400 BROWN LUPTON STUDENT HEALTH CENTER
FORTWORTH TX
76129
US

V. Phone/Fax

Practice location:
  • Phone: 817-257-7940
  • Fax: 817-257-7279
Mailing address:
  • Phone: 817-257-7940
  • Fax: 817-257-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE1410
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: