Provider Demographics
NPI:1942595111
Name:OLIVIA BUTT MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OLIVIA BUTT MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-864-0660
Mailing Address - Street 1:501 S SHORE CTR W STE D
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5759
Mailing Address - Country:US
Mailing Address - Phone:510-864-0660
Mailing Address - Fax:510-864-0393
Practice Address - Street 1:501 S SHORE CTR W STE D
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5759
Practice Address - Country:US
Practice Address - Phone:510-864-0660
Practice Address - Fax:510-864-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106483207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty