Provider Demographics
NPI:1447386099
Name:BUTLER, WENDELL DECAMP (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:DECAMP
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-242-4102
Mailing Address - Fax:702-242-0177
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 502
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-242-4102
Practice Address - Fax:702-242-0177
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019344Medicaid
NV2019344Medicaid
NVC81816Medicare UPIN