1568531960 NPI number — DR. JULIUS CARROLL BUTLER MD

Table of content: DR. JULIUS CARROLL BUTLER MD (NPI 1568531960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568531960 NPI number — DR. JULIUS CARROLL BUTLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
JULIUS
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTLER
Provider Other First Name:
JULIUS
Provider Other Middle Name:
CARROLL
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD., FACOG
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568531960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4359 WINDING HILL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-6254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-329-6346
Provider Business Mailing Address Fax Number:
916-720-0498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4359 WINDING HILL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-6254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-329-6346
Provider Business Practice Location Address Fax Number:
916-720-0498
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G59219 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G59219 . This is a "PHYSICIAN & SURGEON" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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