Provider Demographics
NPI:1275570814
Name:BUTLER, BARRY ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ALEXANDER
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3112
Mailing Address - Country:US
Mailing Address - Phone:507-451-5950
Mailing Address - Fax:507-451-5514
Practice Address - Street 1:803 E SCHOOL ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3112
Practice Address - Country:US
Practice Address - Phone:507-451-5950
Practice Address - Fax:507-451-5514
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN488213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6B283BUOtherBLUE CROSS BLUE SHIELD
MN2707553OtherMEDICA
MN480012951OtherRAILROAD MEDICARE
MNHP21178OtherHEALTHPARTNERS
MN114358D102OtherU-CARE
MN634325200Medicaid
MN2707554OtherMEDICA
MN2707558OtherMEDICA
MN985461010412OtherPREFERREDONE
MNHP21178OtherHEALTHPARTNERS
MNU18237Medicare UPIN
MN985461010412OtherPREFERREDONE