Provider Demographics
NPI:1710161377
Name:BURROWS CLINC
Entity Type:Organization
Organization Name:BURROWS CLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-531-2081
Mailing Address - Street 1:PO BOX 123627
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76121-3627
Mailing Address - Country:US
Mailing Address - Phone:817-531-2801
Mailing Address - Fax:817-534-0652
Practice Address - Street 1:3514 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-5305
Practice Address - Country:US
Practice Address - Phone:817-531-2801
Practice Address - Fax:817-534-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051LBOtherBCBS
TX0051LBOtherBCBS