Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 238124 | NY |
N | 207N00000X | Dermatologist | 25MA08016900 | NJ |
N | 207N00000X | Dermatologist | A100583 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A100583 | CA |
N | 207ND0900X | Dermatopathologist | A100583 | CA |
N | 207NP0225X | Pediatric Dermatologist | A100583 | CA |
N | 207NS0135X | Procedural Dermatology | A100583 | CA |
NPI | 1144373168 |
---|---|
Provider Name | Dr. Anjali Butani |
First Address | Tylertown, MS 39667-2067 |
Second Address | Tustin, CA 92780-7028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2007 |
Last Update Date | 12/12/2018 |