Provider Demographics
NPI:1124007489
Name:BUTLER, JAMES T (NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:BUTLER
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Gender:M
Credentials:NP
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Mailing Address - Street 1:5008 BRITTONFIELD PKWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9248
Mailing Address - Country:US
Mailing Address - Phone:315-472-7504
Mailing Address - Fax:315-479-8639
Practice Address - Street 1:37 W GARDEN ST STE 105
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2663
Practice Address - Country:US
Practice Address - Phone:315-252-0000
Practice Address - Fax:315-252-0070
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-10-13
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Provider Licenses
StateLicense IDTaxonomies
NYF333697-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364941Medicaid
NYQ02444Medicare UPIN
NY02364941Medicaid