Provider Demographics
NPI:1669759080
Name:DAVID A BUTLER DO LLC
Entity type:Organization
Organization Name:DAVID A BUTLER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-629-3500
Mailing Address - Street 1:3005 CARING WAY
Mailing Address - Street 2:STE 2
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5304
Mailing Address - Country:US
Mailing Address - Phone:941-629-3500
Mailing Address - Fax:941-359-3100
Practice Address - Street 1:3005 CARING WAY
Practice Address - Street 2:STE 2
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5304
Practice Address - Country:US
Practice Address - Phone:941-629-3500
Practice Address - Fax:941-359-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFQ284AMedicare PIN