Provider Demographics
NPI:1891911590
Name:DALE R. BUTLER, MD, INC.
Entity Type:Organization
Organization Name:DALE R. BUTLER, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-477-5911
Mailing Address - Street 1:105 CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5705
Mailing Address - Country:US
Mailing Address - Phone:530-477-5911
Mailing Address - Fax:530-477-1021
Practice Address - Street 1:105 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5705
Practice Address - Country:US
Practice Address - Phone:530-477-5911
Practice Address - Fax:530-477-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35311207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C353110Medicaid
CA00C353110Medicare ID - Type Unspecified
CAA35936Medicare UPIN