Provider Demographics
NPI:1821654617
Name:BUTZ, CONNOR JAMES (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JAMES
Last Name:BUTZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 M ST NW STE 401
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1495
Mailing Address - Country:US
Mailing Address - Phone:202-331-3338
Mailing Address - Fax:202-223-9130
Practice Address - Street 1:2311 M ST NW STE 401
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1495
Practice Address - Country:US
Practice Address - Phone:202-331-3338
Practice Address - Fax:202-223-9130
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
DCPA031613363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant