Provider Demographics
NPI:1497942494
Name:JOE BUTLER JR MD PA
Entity Type:Organization
Organization Name:JOE BUTLER JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:941-629-7597
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-629-7597
Mailing Address - Fax:941-629-5070
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-629-7597
Practice Address - Fax:941-629-5070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE COUNTY SURGICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-03
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 39536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D61542Medicare UPIN
FL99863Medicare PIN