Provider Demographics
NPI:1013116987
Name:BUTLER, RICHARD JASON (CPO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JASON
Last Name:BUTLER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5513
Mailing Address - Country:US
Mailing Address - Phone:508-587-7300
Mailing Address - Fax:508-587-7330
Practice Address - Street 1:790 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5513
Practice Address - Country:US
Practice Address - Phone:508-587-7300
Practice Address - Fax:508-587-7330
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist