Provider Demographics
NPI:1881775799
Name:BUTLER NEUROLOGY PC
Entity type:Organization
Organization Name:BUTLER NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAREL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-396-4958
Mailing Address - Street 1:1264 WESLEY DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116
Mailing Address - Country:US
Mailing Address - Phone:901-396-4958
Mailing Address - Fax:901-396-7657
Practice Address - Street 1:1264 WESLEY DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116
Practice Address - Country:US
Practice Address - Phone:901-396-4958
Practice Address - Fax:901-396-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000277522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13422901OtherMEDICAID
TN4075715OtherBCBS
TNP00093158OtherRR MEDICARE
TN13422901OtherMEDICAID
TNP00093158OtherRR MEDICARE