Provider Demographics
NPI:1558584680
Name:BUTLER, RAPHAELLE ANGELA (MD)
Entity Type:Individual
Prefix:MS
First Name:RAPHAELLE
Middle Name:ANGELA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:95524-0263
Mailing Address - Country:US
Mailing Address - Phone:707-464-7224
Mailing Address - Fax:707-465-4272
Practice Address - Street 1:206 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8301
Practice Address - Country:US
Practice Address - Phone:707-464-7224
Practice Address - Fax:707-465-4272
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAB55781352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24239Medicare UPIN