Provider Demographics
NPI:1962490870
Name:BUTLER, KATHLEEN VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VICTORIA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:512-868-9894
Practice Address - Street 1:205 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6821
Practice Address - Country:US
Practice Address - Phone:512-868-1124
Practice Address - Fax:512-868-9894
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143093605Medicaid
TX119934OtherSUPERIOR
TX8X1635OtherBLUE CROSS
TX8X1635OtherBLUE CROSS