MEDICARE: MARK H BUSSELL MD

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	208100000X	Physical Medicine & Rehabilitation Physician	J0452	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922041599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK H BUSSELL MD

Provider Business Mailing Address
First Line	:	6901 RIVER PARK CIRCLE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-8465
Country	:	US
Telephone Number	:	817-732-0800
Fax Number	:	817-956-9119

Provider Business Practice Location Address
First Line	:	6116 OAKBEND TRAIL
Second Line	:	112
City	:	FT WORTH
State	:	TX
Zip	:	76132-3926
Country	:	US
Telephone Number	:	817-346-7800
Fax Number	:	817-346-7408

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	12/01/2010

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