Provider Demographics
NPI:1386713691
Name:ZUNG, BURTON J (PHD)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:J
Last Name:ZUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 WESTCREEK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2254
Mailing Address - Country:US
Mailing Address - Phone:972-424-9212
Mailing Address - Fax:972-509-1450
Practice Address - Street 1:5658 WESCREEK DR STE 400
Practice Address - Street 2:STE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133
Practice Address - Country:US
Practice Address - Phone:972-424-9212
Practice Address - Fax:972-509-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21099103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U49FOtherBLUE CROSS
TX21099OtherTEXAS LICENSE