Provider Demographics
NPI:1578590592
Name:BUTLER, RHETT HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:HENRY
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9107
Mailing Address - Country:US
Mailing Address - Phone:203-788-3093
Mailing Address - Fax:
Practice Address - Street 1:2210 JUNIPER CT
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9107
Practice Address - Country:US
Practice Address - Phone:203-788-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148090207P00000X
CAA040683207P00000X
CO48811207P00000X
CT047820207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA29180Medicare UPIN