Provider Demographics
NPI:1417927419
Name:BUTLER, HEATHER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:#200
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-793-7790
Mailing Address - Fax:626-793-9018
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:#200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-793-7790
Practice Address - Fax:626-793-9018
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30345207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30345AMedicare ID - Type Unspecified
A91280Medicare UPIN