Provider Demographics
NPI:1831107341
Name:BUTLER, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:444 HOSPITAL WAY
Mailing Address - Street 2:SUITE 801
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2745
Mailing Address - Country:US
Mailing Address - Phone:208-232-6214
Mailing Address - Fax:208-233-3416
Practice Address - Street 1:444 HOSPITAL WAY
Practice Address - Street 2:SUITE 801
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2745
Practice Address - Country:US
Practice Address - Phone:208-232-6214
Practice Address - Fax:208-233-3416
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-11155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine