Provider Demographics
NPI:1154094647
Name:BUTLER, JEFFREY BRIAN (CPRSS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRIAN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JAMAICA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6132
Mailing Address - Country:US
Mailing Address - Phone:775-233-4778
Mailing Address - Fax:
Practice Address - Street 1:800 JAMAICA AVE APT 1
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6132
Practice Address - Country:US
Practice Address - Phone:775-233-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5064175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty