Provider Demographics
NPI:1366638298
Name:DAVID T. BUTLER, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID T. BUTLER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TANKSLEY
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-258-5800
Mailing Address - Street 1:11940 JOLLYVILLE RD STE 115SOUTH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2327
Mailing Address - Country:US
Mailing Address - Phone:512-258-5800
Mailing Address - Fax:512-258-5310
Practice Address - Street 1:11940 JOLLYVILLE RD STE 115SOUTH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2327
Practice Address - Country:US
Practice Address - Phone:512-258-5800
Practice Address - Fax:512-258-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK-4866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002244WOtherMEDICARE GROUP NUMBER
TX45D1020456OtherCLIA