Provider Demographics
NPI:1265479950
Name:BUTLER, BRADLEY STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:STEVEN
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 1:5086 E ROMA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4435
Mailing Address - Country:US
Mailing Address - Phone:602-741-6321
Mailing Address - Fax:602-466-1763
Practice Address - Street 1:4730 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 211
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5441
Practice Address - Country:US
Practice Address - Phone:602-354-3491
Practice Address - Fax:602-354-3491
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23431207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ 114120OtherMEDICARE PIN:EMURGENTCARE
AZP00379356OtherRAILROAD ID
AZ34667821Medicaid
AZZ 114120OtherMEDICARE PIN:EMURGENTCARE
G33658Medicare UPIN