Provider Demographics
NPI:1245323898
Name:BUTTS, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BUTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1442 N 8TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1027
Mailing Address - Country:US
Mailing Address - Phone:618-283-0266
Mailing Address - Fax:618-283-0519
Practice Address - Street 1:1442 N 8TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1027
Practice Address - Country:US
Practice Address - Phone:618-283-0266
Practice Address - Fax:618-283-0519
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036096697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG77620Medicare UPIN