Provider Demographics
NPI:1740527589
Name:BUTLER, CORY JOHN (IDC)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:JOHN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WORCHESTER AVE BLDG 45
Mailing Address - Street 2:
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96853-5530
Mailing Address - Country:US
Mailing Address - Phone:808-474-4737
Mailing Address - Fax:
Practice Address - Street 1:310 WORCHESTER AVE BLDG 45
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96853-5530
Practice Address - Country:US
Practice Address - Phone:808-474-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman