Provider Demographics
NPI:1972768208
Name:FREDRICK BUTLER II, MD, INC
Entity Type:Organization
Organization Name:FREDRICK BUTLER II, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:818-957-9595
Mailing Address - Street 1:15332 ANTIOCH ST
Mailing Address - Street 2:SUITE 820
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3628
Mailing Address - Country:US
Mailing Address - Phone:310-295-0079
Mailing Address - Fax:
Practice Address - Street 1:10657 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2222
Practice Address - Country:US
Practice Address - Phone:310-295-0079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427088830OtherNPI