Provider Demographics
NPI:1831246842
Name:BUTTS, JEFFREY L (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:BUTTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:37131 INTERSTATE 10 W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8989
Mailing Address - Country:US
Mailing Address - Phone:830-249-8400
Mailing Address - Fax:830-255-4660
Practice Address - Street 1:37131 INTERSTATE 10 W
Practice Address - Street 2:SUITE 101
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8989
Practice Address - Country:US
Practice Address - Phone:830-249-8400
Practice Address - Fax:830-255-4660
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH7939207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB9367586OtherDEA USD SAMSHA
XB9367586OtherXDEA USD SAMSHA
XB9367586OtherXDEA USD SAMSHA
TX00L31GMedicare ID - Type Unspecified
BB9367586OtherDEA USD SAMSHA