Provider Demographics
NPI:1194487512
Name:BUTLER, WALTER JAMESON
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMESON
Last Name:BUTLER
Suffix:
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 1:2301 E FORT MACON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-5633
Mailing Address - Country:US
Mailing Address - Phone:252-240-8445
Mailing Address - Fax:252-240-8447
Practice Address - Street 1:2310 E FORT MACON RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NC
Practice Address - Zip Code:28512
Practice Address - Country:US
Practice Address - Phone:252-240-8445
Practice Address - Fax:252-240-8447
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman