Provider Demographics
NPI:1083623003
Name:BUTLER, TADA KAREN (DO)
Entity Type:Individual
Prefix:DR
First Name:TADA
Middle Name:KAREN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 DUNWOODY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8889
Mailing Address - Country:US
Mailing Address - Phone:870-483-1075
Mailing Address - Fax:870-483-0244
Practice Address - Street 1:201 HIGHWAY 463 N
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-3503
Practice Address - Country:US
Practice Address - Phone:870-483-1075
Practice Address - Fax:870-483-0244
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARI22530Medicare UPIN
AR5N044Medicare ID - Type Unspecified