Provider Demographics
NPI:1952413338
Name:BUTLER, EUGENE WHEELER (MED, EDD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:WHEELER
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MED, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILDEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1084
Mailing Address - Country:US
Mailing Address - Phone:508-754-6133
Mailing Address - Fax:508-754-6133
Practice Address - Street 1:68 JAQUES AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2476
Practice Address - Country:US
Practice Address - Phone:508-860-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1340103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist