Provider Demographics
NPI:1891707287
Name:BUTCHER, STEVEN R (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-326-6000
Mailing Address - Fax:417-328-6338
Practice Address - Street 1:1521 S 3RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-9608
Practice Address - Country:US
Practice Address - Phone:417-276-5131
Practice Address - Fax:417-276-6498
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR1R79207Q00000X
MOR1R79207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10715Medicare UPIN
MO023013888Medicare PIN