Provider Demographics
NPI:1942969761
Name:BUTLER, RONALD (BA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4205
Mailing Address - Country:US
Mailing Address - Phone:270-779-2987
Mailing Address - Fax:
Practice Address - Street 1:5966 SCOTTSVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7908
Practice Address - Country:US
Practice Address - Phone:270-904-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program