Provider Demographics
NPI:1609960541
Name:BUTLER, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1150 ROBERT BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2005
Mailing Address - Country:US
Mailing Address - Phone:985-646-3662
Mailing Address - Fax:985-646-3691
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-3662
Practice Address - Fax:985-646-3691
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014621207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1189863Medicaid
LAB89351Medicare UPIN
LA50649Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER