Provider Demographics
NPI:1043226780
Name:BUTROS, LINDA J (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:BUTROS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1516 GRAY ROCK PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6639
Mailing Address - Country:US
Mailing Address - Phone:505-636-0728
Mailing Address - Fax:505-212-4132
Practice Address - Street 1:1804 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-636-0728
Practice Address - Fax:505-212-4132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2004-05112080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02071843Medicaid