Provider Demographics
NPI:1093442311
Name:BUTLER, STEVEN JR
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8363 W VAN BUREN ST BLDG D-2
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-3226
Mailing Address - Country:US
Mailing Address - Phone:623-205-3819
Mailing Address - Fax:
Practice Address - Street 1:8363 W VAN BUREN ST BLDG D-2
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-3226
Practice Address - Country:US
Practice Address - Phone:623-205-3819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals