Provider Demographics
NPI:1043969405
Name:AVANDY MEDICAL BUTTRUM PLLC
Entity Type:Organization
Organization Name:AVANDY MEDICAL BUTTRUM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-508-2153
Mailing Address - Street 1:660 S GREEN VALLEY PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0431
Mailing Address - Country:US
Mailing Address - Phone:702-508-2153
Mailing Address - Fax:702-508-2435
Practice Address - Street 1:660 S GREEN VALLEY PKWY STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0431
Practice Address - Country:US
Practice Address - Phone:702-508-2453
Practice Address - Fax:702-508-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15199OtherPRIMARY CARE