Provider Demographics
NPI:1477514453
Name:BUTLER, JENNY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1795 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-2112
Mailing Address - Country:US
Mailing Address - Phone:319-462-6131
Mailing Address - Fax:319-462-4689
Practice Address - Street 1:1795 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-2112
Practice Address - Country:US
Practice Address - Phone:319-462-6131
Practice Address - Fax:319-462-4689
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI38685Medicare UPIN
IAI15783Medicare PIN