Provider Demographics
NPI:1801040209
Name:BUTT, MUHAMMAD USMAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:USMAN
Last Name:BUTT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 S 130TH EAST AVE
Mailing Address - Street 2:APT # 1113
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-1132
Mailing Address - Country:US
Mailing Address - Phone:918-814-7468
Mailing Address - Fax:
Practice Address - Street 1:4120 S 130TH EAST AVE
Practice Address - Street 2:APT # 1113
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-1132
Practice Address - Country:US
Practice Address - Phone:918-814-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0075409367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered