Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22475 | FL |
Y | 1223G0001X | General Practice | DN22475 | FL |
Y | 213EG0000X | General Practice | DN22475 | FL |
NPI | 1003357351 |
---|---|
Provider Name | Dr. Latoya Shemia Butler |
First Address | Tallahassee, FL 32308-5439 |
Second Address | Havana, FL 32333-1442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2017 |
Last Update Date | 12/04/2018 |