Provider Demographics
NPI:1578556510
Name:BUTLER, TRACY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JEAN
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 1:2055 N HIGH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5507
Mailing Address - Country:US
Mailing Address - Phone:303-839-7440
Mailing Address - Fax:855-516-0354
Practice Address - Street 1:2055 N HIGH ST STE 250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5507
Practice Address - Country:US
Practice Address - Phone:303-839-7440
Practice Address - Fax:855-516-0354
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10261208000000X, 2080P0203X
CO49393208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH22634Medicare UPIN
NV36881Medicare ID - Type Unspecified