Provider Demographics
NPI:1184651895
Name:BUTLER, IAN J (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:1010
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7151
Practice Address - Fax:713-512-2248
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE67392084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139295308OtherCSHCN
TX139295306Medicaid
TX87X553OtherBCBS
TX139295317OtherCSHCN
TX139295316Medicaid
TX8U4869OtherBCBSTX
TX139295316Medicaid
TX87X553Medicare PIN
C14009Medicare UPIN