Provider Demographics
NPI:1659300093
Name:BUTLER, HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
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 1:5700 LAKE WORTH RD
Mailing Address - Street 2:#204
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4727
Mailing Address - Country:US
Mailing Address - Phone:561-968-7968
Mailing Address - Fax:561-964-4603
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:STE 105
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-642-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 506442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E34115Medicare UPIN