MEDICARE: BURTON J ZUNG PHD

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	103G00000X	Clinical Neuropsychologist	21099	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00U49F	OTHER	TX	BLUE CROSS
2	21099	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1386713691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BURTON J ZUNG PHD

Provider Business Mailing Address
First Line	:	5658 WESTCREEK DR STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2254
Country	:	US
Telephone Number	:	972-424-9212
Fax Number	:	972-509-1450

Provider Business Practice Location Address
First Line	:	5658 WESCREEK DR STE 400
Second Line	:	STE 400
City	:	FORT WORTH
State	:	TX
Zip	:	76133
Country	:	US
Telephone Number	:	972-424-9212
Fax Number	:	972-509-1450

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	11/03/2011

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Directions to “ BURTON J ZUNG PHD” Practice Location

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