Provider Demographics
NPI:1326045048
Name:BUTLER, ALLEN P (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:P
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 1:2406 LIGHTHOUSE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7401
Mailing Address - Country:US
Mailing Address - Phone:770-536-4352
Mailing Address - Fax:770-532-8165
Practice Address - Street 1:2406 LIGHTHOUSE MANOR DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7401
Practice Address - Country:US
Practice Address - Phone:770-536-4352
Practice Address - Fax:770-532-8165
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14873R207Y00000X
GA52260207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1151262Medicaid
LAP00074444Medicare PIN
LA1151262Medicaid
LA4F109Medicare PIN
LAH83381Medicare UPIN