Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A115294 | CA |
N | 111NI0900X | Internist | A115294 | CA |
NPI | 1003058991 |
---|---|
Provider Name | Brian Butler |
First Address | San Diego, CA 92121-1520 |
Second Address | San Diego, CA 92103-2105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 15/05/2020 |