Provider Demographics
NPI:1679519391
Name:BUTLER, KEITH CLAUDE (MD MBA FACEP CPE)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:CLAUDE
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD MBA FACEP CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S VAL VISA
Mailing Address - Street 2:SUITE A3-624
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1335
Mailing Address - Country:US
Mailing Address - Phone:877-336-6898
Mailing Address - Fax:
Practice Address - Street 1:70 S VAL VISA
Practice Address - Street 2:SUITE A3-624
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1335
Practice Address - Country:US
Practice Address - Phone:877-336-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26876207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG93634Medicare UPIN