Provider Demographics
NPI:1821384694
Name:BUTLER, BRENDAN FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:FRANCIS
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1333 E BARNETT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8219
Mailing Address - Country:US
Mailing Address - Phone:541-779-4711
Mailing Address - Fax:541-210-8710
Practice Address - Street 1:1333 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8219
Practice Address - Country:US
Practice Address - Phone:541-779-4711
Practice Address - Fax:541-779-0796
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171455207W00000X, 207WX0009X
MI4301099119390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500683767Medicaid