Provider Demographics
NPI:1053632034
Name:BUTLER, IAN B (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:B
Last Name:BUTLER
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 1:3231 WARING CT STE D
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4510
Mailing Address - Country:US
Mailing Address - Phone:760-941-0221
Mailing Address - Fax:760-941-0905
Practice Address - Street 1:3231 WARING CT STE D
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:760-941-0221
Practice Address - Fax:760-941-0905
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5896207RC0200X
CAC137716207RC0200X
PAMD439803207LC0200X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine