Provider Demographics
NPI:1558400770
Name:BUTTROSS, CAROLYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:BUTTROSS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2112 BIENVILLE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3052
Mailing Address - Country:US
Mailing Address - Phone:228-872-7705
Mailing Address - Fax:228-872-7746
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3052
Practice Address - Country:US
Practice Address - Phone:228-872-7705
Practice Address - Fax:228-872-7746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MS060162080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018375Medicaid