Provider Demographics
NPI:1396847984
Name:BUTLER, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
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 1:4501 S 70TH ST
Mailing Address - Street 2:STE 140
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4201
Mailing Address - Country:US
Mailing Address - Phone:402-484-5100
Mailing Address - Fax:
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:STE 140
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4282
Practice Address - Country:US
Practice Address - Phone:402-484-5100
Practice Address - Fax:402-484-5151
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
30671OtherBCBS
NE00210OtherBCBS
3842OtherMIDLANDS CHOICE
NE470780857 32Medicaid
01-00472OtherUHC
NE01-03334OtherUHC
NE01-03334OtherUHC
30671OtherBCBS