Provider Demographics
NPI:1679565972
Name:BUTLER, EDWARD BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRIAN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE AX121B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-4800
Mailing Address - Fax:713-793-1300
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE AX121B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-4800
Practice Address - Fax:713-793-1300
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH58512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134714810OtherMEDICAID CSHCN
TX920002585OtherRR MEDICARE
WY134714808Medicaid
TX134714809Medicaid
TX8BC022OtherBLUE CROSS BLUE SHIELD
TX134714803Medicaid
TX134714808Medicaid
TX134714802Medicaid
TXP00662607OtherMEDICARE RAILROAD
E48375Medicare UPIN
WY134714808Medicaid
TX134714808Medicaid
TX134714802Medicaid
TX8K8493Medicare PIN