Provider Demographics
NPI:1255661641
Name:BUTERBAUGH, JOHN CARL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:BUTERBAUGH
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 1:4609 VICTORIA BEACH WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-5363
Mailing Address - Country:US
Mailing Address - Phone:702-395-0655
Mailing Address - Fax:
Practice Address - Street 1:4609 VICTORIA BEACH WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-5363
Practice Address - Country:US
Practice Address - Phone:702-395-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA028125L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice