Provider Demographics
NPI:1770873879
Name:BUTLER, JONATHAN TY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TY
Last Name:BUTLER
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:RIVERSIDE MEDICAL GROUP
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:12200 WARWICK BLVD STE 110
Practice Address - Street 2:RIVERSIDE NEUROLOGY SPECIALISTS
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-5100
Practice Address - Fax:757-534-5395
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-08-08
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Provider Licenses
StateLicense IDTaxonomies
VA01012600742084N0400X
TNMD523172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology