# MARK H BUSSELL MD CPO PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376763946
- **Authorized official:** MS. RUTH A GOLDEN (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (817) 346-7800

## Contact information

- **Practice address:** 6116 OAK BEND TRAIL, STE 112, FT WORTH, TX 76132-4203
- **Practice address phone:** (817) 346-7800
- **Practice address fax:** (817) 346-7804
- **Mailing address:** 6116 OAKBEND TRL, SUITE 112, FT WORTH, TX 76132-3925
- **Mailing address phone:** (817) 732-0800
- **Mailing address fax:** (817) 596-5119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | J0452 | TX | Yes |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 11/23/2011