Provider Demographics
NPI:1669488912
Name:BUTZINE, PAUL RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RAYMOND
Last Name:BUTZINE
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 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:STE 221
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-214-1141
Mailing Address - Fax:623-214-8903
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:STE 221
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-214-1141
Practice Address - Fax:623-214-8903
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ260027113OtherRRMED
AZZ28837Medicare PIN
C99225Medicare UPIN