Provider Demographics
NPI:1134221369
Name:BUTERA, LOIUS J (DO)
Entity type:Individual
Prefix:
First Name:LOIUS
Middle Name:J
Last Name:BUTERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 N CONGRESS AVE
Mailing Address - Street 2:200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-845-0500
Mailing Address - Fax:561-296-1101
Practice Address - Street 1:4631 N CONGRESS AVE
Practice Address - Street 2:200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-845-0500
Practice Address - Fax:561-296-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 51462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82889YMedicare PIN
FLD60757Medicare UPIN
82889Medicare ID - Type Unspecified