Provider Demographics
NPI:1720312077
Name:BUTTON, JOSHUA ANDY (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANDY
Last Name:BUTTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4213
Mailing Address - Country:US
Mailing Address - Phone:480-299-2845
Mailing Address - Fax:
Practice Address - Street 1:1310 E 7TH ST
Practice Address - Street 2:SUITE J
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2534
Practice Address - Country:US
Practice Address - Phone:260-925-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4495363A00000X
IN10001389B363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant