Provider Demographics
NPI:1609807163
Name:BUTLER, MELVIN L (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:L
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 1:28 WHITE BRIDGE ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1467
Mailing Address - Country:US
Mailing Address - Phone:615-352-3000
Mailing Address - Fax:615-352-6673
Practice Address - Street 1:28 WHITE BRIDGE ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1467
Practice Address - Country:US
Practice Address - Phone:615-352-3000
Practice Address - Fax:615-352-6673
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036764207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3878042Medicaid
TN3878042Medicaid
TN3878042Medicare PIN