Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 12943 | TX |
NPI | 1407972938 |
---|---|
Provider Name | Dr. Ronald Clay De Lyrh Butler |
First Address | El Paso, TX 79912 |
Second Address | El Paso, TX 79912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |