Provider Demographics
NPI:1770581449
Name:BUTLER, BARRY (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
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 1:3880 COLONIAL BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1062
Mailing Address - Country:US
Mailing Address - Phone:239-936-1233
Mailing Address - Fax:239-936-8576
Practice Address - Street 1:20 BARKLEY CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4545
Practice Address - Country:US
Practice Address - Phone:239-277-1772
Practice Address - Fax:239-277-1331
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-05-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME100125207R00000X
NJMA50415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM311WMedicare PIN
FLF25205Medicare UPIN
FLAM311YMedicare PIN