Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | P7402 | TX |
NPI | 1285620203 |
---|---|
Provider Name | Dr. Gary J Butchko |
First Address | Corpus Christi, TX 78411-1721 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 02/10/2013 |