Provider Demographics
NPI:1588608665
Name:BUTLER, PETER N (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:N
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 1:543A FONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2018
Mailing Address - Country:US
Mailing Address - Phone:850-476-3223
Mailing Address - Fax:850-476-1948
Practice Address - Street 1:543A FONTAINE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2018
Practice Address - Country:US
Practice Address - Phone:850-476-3223
Practice Address - Fax:850-476-1948
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH18560Medicare UPIN
FL17063Medicare ID - Type Unspecified