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General NPI Number Information
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NPI Number | 1710161377
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Entity Type | Organization
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Legal Business Name | BURROWS CLINC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 3514 E BERRY ST
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City | FORT WORTH
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State | TX
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Zip | 76105-5305
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Country | US
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Telephone | 817-531-2801
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Fax | 817-534-0652
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Provider Business Mailing Address
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Address Line | PO BOX 123627
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City | FORT WORTH
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State | TX
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Zip | 76121-3627
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Country | US
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Telephone | 817-531-2801
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Fax | 817-534-0652
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Authorized Official
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Title or Position | OWNER
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Name | LARRY G. BURROWS
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Credential | D.O.
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Telephone | 817-531-2081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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