Provider Demographics
NPI:1922031566
Name:BLAIR T BUTTERFIELD, PC
Entity Type:Organization
Organization Name:BLAIR T BUTTERFIELD, PC
Other - Org Name:BLAIR T BUTTERFIELD, DO, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-751-3091
Mailing Address - Street 1:1156 S FERN CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3673
Mailing Address - Country:US
Mailing Address - Phone:480-751-3091
Mailing Address - Fax:480-751-3095
Practice Address - Street 1:4135 S POWER RD
Practice Address - Street 2:SUITE 129
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3624
Practice Address - Country:US
Practice Address - Phone:480-751-3091
Practice Address - Fax:480-751-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ758899Medicaid
AZ758899Medicaid
AZZ109956Medicare PIN