Provider Demographics
NPI:1952664773
Name:BUTCHER, ANDREW R (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9008
Mailing Address - Country:US
Mailing Address - Phone:681-342-3600
Mailing Address - Fax:681-342-2500
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9008
Practice Address - Country:US
Practice Address - Phone:681-342-3600
Practice Address - Fax:681-342-2500
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
WV2809207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program