Provider Demographics
NPI:1407020563
Name:JONATHAN B BUTEN MD PA
Entity Type:Organization
Organization Name:JONATHAN B BUTEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-795-2009
Mailing Address - Street 1:PO BOX 268866
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8866
Mailing Address - Country:US
Mailing Address - Phone:512-795-2009
Mailing Address - Fax:512-241-3776
Practice Address - Street 1:1401 MEDICAL PKWY # B
Practice Address - Street 2:SUITE 311
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7642
Practice Address - Country:US
Practice Address - Phone:512-795-2009
Practice Address - Fax:512-241-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1959512-01Medicaid
TX1959512-01Medicaid