Provider Demographics
NPI:1417054495
Name:BUTEN, JONATHAN BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BERNARD
Last Name:BUTEN
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 1:1401 MEDICAL PKWY STE 311
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5014
Mailing Address - Country:US
Mailing Address - Phone:512-795-2009
Mailing Address - Fax:512-241-3776
Practice Address - Street 1:1401 MEDICAL PKWY BLDG 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1311110-07Medicaid
TX319857YKR0OtherMEDICARE
TX1311110-07Medicaid
TX8K8930Medicare PIN