Provider Demographics
NPI:1003904509
Name:BUTH, RODNEY KYLE I (OPA-C)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:KYLE
Last Name:BUTH
Suffix:I
Gender:M
Credentials:OPA-C
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Mailing Address - Street 1:7720 MARBLE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4156
Mailing Address - Country:US
Mailing Address - Phone:817-919-9671
Mailing Address - Fax:817-731-4282
Practice Address - Street 1:6311 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-1063
Practice Address - Country:US
Practice Address - Phone:817-731-9400
Practice Address - Fax:817-731-4282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical