Provider Demographics
NPI:1750495578
Name:BUTCHER, DENNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:BUTCHER
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 1:555 E BROADWAY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-8640
Mailing Address - Country:US
Mailing Address - Phone:307-733-7222
Mailing Address - Fax:307-733-9720
Practice Address - Street 1:555 E BROADWAY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:307-733-7222
Practice Address - Fax:307-733-9720
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY2906A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106601300Medicaid
WY116969600Medicaid
WY106601300Medicaid
WYW311176Medicare PIN
WY116969600Medicaid