Provider Demographics
NPI:1164469862
Name:BUTCHER, DAVID BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRYAN
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:648 PROGRESS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8602
Mailing Address - Country:US
Mailing Address - Phone:989-345-0204
Mailing Address - Fax:989-345-3727
Practice Address - Street 1:648 PROGRESS ST STE 101
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8602
Practice Address - Country:US
Practice Address - Phone:989-345-0204
Practice Address - Fax:989-345-3727
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076020207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H26358Medicare ID - Type Unspecified