MEDICARE: MELODY A. BURTON, DO, PA

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	208000000X	Pediatrics Physician	J8936	TX

General Provider Information

NPI Number	:	1962773226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELODY A. BURTON, DO, PA

Provider Business Mailing Address
First Line	:	2140 HIGHWAY 157 N
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4847
Country	:	US
Telephone Number	:	817-453-7770
Fax Number	:	817-453-7703

Provider Business Practice Location Address
First Line	:	2140 HIGHWAY 157 N
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4847
Country	:	US
Telephone Number	:	817-453-7770
Fax Number	:	817-453-7703

Authorized Official
Title or Position	:	OWNER
Name	:	MELODY BURTON
Credential	:	D.O.
Telephone Number	:	817-453-7770

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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