Provider Demographics
NPI:1023137189
Name:ALFRED BUTNER, M.D. INC.
Entity type:Organization
Organization Name:ALFRED BUTNER, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-960-1100
Mailing Address - Street 1:PO BOX 1495
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023-1495
Mailing Address - Country:US
Mailing Address - Phone:650-960-1100
Mailing Address - Fax:650-964-0991
Practice Address - Street 1:2204 GRANT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3855
Practice Address - Country:US
Practice Address - Phone:650-960-1100
Practice Address - Fax:650-964-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16357208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39773Medicare UPIN
CAZZZ24034ZMedicare ID - Type Unspecified