Provider Demographics
NPI:1487646964
Name:BUTLER, STEPHEN ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5301 F STREET
Mailing Address - Street 2:STE 313
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3222
Mailing Address - Country:US
Mailing Address - Phone:916-736-6470
Mailing Address - Fax:916-736-6798
Practice Address - Street 1:5151 F STREET 2 SOUTH
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3222
Practice Address - Country:US
Practice Address - Phone:916-733-8441
Practice Address - Fax:916-733-1728
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG415582080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G415580Medicaid
CAZZZ006575ZMedicare ID - Type Unspecified
G13556Medicare UPIN