Provider Demographics
NPI:1912003864
Name:BUTLER, THOMAS JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFREY
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LOCUST STREET
Mailing Address - Street 2:SUITE 540
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1809
Mailing Address - Country:US
Mailing Address - Phone:330-543-8348
Mailing Address - Fax:330-543-8356
Practice Address - Street 1:300 LOCUST STREET
Practice Address - Street 2:SUITE 540
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1809
Practice Address - Country:US
Practice Address - Phone:330-543-8348
Practice Address - Fax:330-543-8356
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070867B2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346405Medicaid