Provider Demographics
NPI:1205888385
Name:BUTLER, JESSE PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:PAUL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2514 VILLAGE GREEN PL
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7675
Mailing Address - Country:US
Mailing Address - Phone:773-321-2800
Mailing Address - Fax:773-321-2801
Practice Address - Street 1:1120 N MELVIN ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1477
Practice Address - Country:US
Practice Address - Phone:217-784-4340
Practice Address - Fax:217-784-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-094206207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3794001OtherMEDICARE PTAN