Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DE00006993 | WA |
NPI | 1083888150 |
---|---|
Provider Name | Dr. Bobby Lynn Butler |
First Address | Seattle, WA 98103-9155 |
Second Address | Seattle, WA 98101-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 04/12/2020 |