Provider Demographics
NPI:1780835686
Name:BUTCH, JEFFREY MATTHEW (APN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:BUTCH
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 FORTRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1351
Mailing Address - Country:US
Mailing Address - Phone:304-225-2500
Mailing Address - Fax:
Practice Address - Street 1:423 FORTRESS BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1351
Practice Address - Country:US
Practice Address - Phone:304-225-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247955363LF0000X
PASP010350363LF0000X
MDR246090363LF0000X
FLAPRN11009358363LF0000X
TXAP139161363LF0000X
NJ26NJ00171600363LF0000X
IL277001156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139943XVAMedicare UPIN