Provider Demographics
NPI:1861455321
Name:BUTLER, BROOKS A (MD)
Entity Type:Individual
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First Name:BROOKS
Middle Name:A
Last Name:BUTLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41104A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7980
Practice Address - Fax:651-254-7969
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN16927208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94704Medicare UPIN