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General NPI Number Information
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NPI Number | 1922041599
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Entity Type | Individual
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Provider Name | MARK H BUSSELL MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 6116 OAKBEND TRAIL 112
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City | FT WORTH
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State | TX
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Zip | 76132-3926
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Country | US
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Telephone | 817-346-7800
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Fax | 817-346-7408
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Provider Business Mailing Address
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Address Line | 6901 RIVER PARK CIRCLE
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City | FT WORTH
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State | TX
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Zip | 76116-8465
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Country | US
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Telephone | 817-732-0800
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Fax | 817-956-9119
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | J0452
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License Number State | TX
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