Provider Demographics
NPI:1780626531
Name:BUTZ, RICHARD A (RPA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:BUTZ
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNTAIN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12812-0151
Mailing Address - Country:US
Mailing Address - Phone:518-352-7737
Mailing Address - Fax:518-346-4030
Practice Address - Street 1:1322 GERLING ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-1702
Practice Address - Country:US
Practice Address - Phone:518-345-3334
Practice Address - Fax:518-346-4030
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006779-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant