MEDICARE: BURROWS CLINC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0051LB	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1710161377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURROWS CLINC

Provider Business Mailing Address
First Line	:	PO BOX 123627
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76121-3627
Country	:	US
Telephone Number	:	817-531-2801
Fax Number	:	817-534-0652

Provider Business Practice Location Address
First Line	:	3514 E BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-5305
Country	:	US
Telephone Number	:	817-531-2801
Fax Number	:	817-534-0652

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY G. BURROWS
Credential	:	D.O.
Telephone Number	:	817-531-2081

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/19/2007

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