Provider Demographics
NPI:1790586287
Name:BUTZ, JAMES AARON (CCSS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:AARON
Last Name:BUTZ
Suffix:
Gender:
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 S SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5361
Mailing Address - Country:US
Mailing Address - Phone:575-936-4227
Mailing Address - Fax:575-936-4658
Practice Address - Street 1:1419 S SANTA BARBARA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5361
Practice Address - Country:US
Practice Address - Phone:575-936-4227
Practice Address - Fax:575-936-4658
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty