Provider Demographics
NPI:1780791913
Name:BUTLER, DANA ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ANDREW
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 1:904 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3924
Mailing Address - Country:US
Mailing Address - Phone:806-766-0273
Mailing Address - Fax:806-766-0350
Practice Address - Street 1:1950 ASPEN AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-1211
Practice Address - Country:US
Practice Address - Phone:806-766-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
TXG32032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0355323-01Medicaid
TX00QX55Medicare ID - Type Unspecified
TX0355323-01Medicaid