Provider Demographics
NPI:1013027655
Name:BUTZ, GERALD W (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:BUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SAINT ANNE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4670
Mailing Address - Country:US
Mailing Address - Phone:605-348-4100
Mailing Address - Fax:605-348-0662
Practice Address - Street 1:710 SAINT ANNE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4670
Practice Address - Country:US
Practice Address - Phone:605-348-4100
Practice Address - Fax:605-348-0662
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2297208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7500082Medicaid
SDS440OtherMEDICARE SD
SD0000440OtherBLUE CROSS BLUE SHIELD
SD23142OtherSIOUX VALLEY HEALTH PLAN
WY310276OtherBLUE CROSS BLUE SHIELD
SD23142OtherSANFORD HEALTH
SD2297OtherDAKOTACARE
SD2297OtherDAKOTACARE
SD440Medicare ID - Type Unspecified
WY310276OtherBLUE CROSS BLUE SHIELD