Provider Demographics
NPI:1881061901
Name:BUTTARS, PAUL ROBERT (DO, MS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:BUTTARS
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2800
Mailing Address - Country:US
Mailing Address - Phone:641-530-2246
Mailing Address - Fax:641-428-7988
Practice Address - Street 1:251 E HURON ST STE 7-220
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-503-8144
Practice Address - Fax:312-926-3127
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05544207ZP0102X
IL036164890207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881061901Medicaid