Provider Demographics
NPI:1710142484
Name:BUTLER, JASON ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0951
Mailing Address - Country:US
Mailing Address - Phone:817-419-6111
Mailing Address - Fax:817-419-9582
Practice Address - Street 1:74 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7816
Practice Address - Country:US
Practice Address - Phone:817-419-6111
Practice Address - Fax:817-419-9582
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN0671207Q00000X, 208VP0014X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine