Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 26174 | MS |
N | 207RC0000X | Internist - Cardiovascular Disease | 31361 | TN |
NPI | 1639100928 |
---|---|
Provider Name | Javed Butler |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 11/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
083484803A | (05) | GA |
3836286 | (05) | TN |
64722093 | (05) | KY |
F89165 | (02) | TN |