Provider Demographics
NPI:1750339784
Name:BUTLER, WARREN MAYNARD (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MAYNARD
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR
Mailing Address - Street 2:STE 125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4581
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-819-6119
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:STE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4581
Practice Address - Country:US
Practice Address - Phone:480-455-3000
Practice Address - Fax:866-819-6119
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0764700207R00000X
AZ41991208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ475710Medicaid
AZZ188495Medicare PIN
AZZ155197Medicare PIN
NJ101260PXEMedicare PIN
NJ2742819000OtherAMERIHEALTH
NJP3686732OtherOXFORD
NJ60022829OtherHORIZON NJ HEALTH
NJ91002082200OtherAMERICHOICE OF NJ
NJP00610730OtherRAILROAD MEDICARE
NJG44317Medicare UPIN
NJ101260Medicare PIN
AZZ155197Medicare PIN