Provider Demographics
NPI:1275677726
Name:BUTLER, ROBERT BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRYAN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13837 CIRCA CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4382
Mailing Address - Country:US
Mailing Address - Phone:813-684-2663
Mailing Address - Fax:813-658-6222
Practice Address - Street 1:13837 CIRCA CROSSING DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4382
Practice Address - Country:US
Practice Address - Phone:813-684-2663
Practice Address - Fax:813-658-6222
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123591207X00000X
MA239902207X00000X
OH35096453207XS0106X
SC36223207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14700700Medicaid
FLID552ZMedicare PIN