Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | H7939 | TX |
NPI | 1831246842 |
---|---|
Provider Name | Jeffrey L Butts |
First Address | Boerne, TX 78006-8989 |
Second Address | Boerne, TX 78006-8989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 25/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BB9367586 | DEA USD SAMSHA (01) | |
E82726 | (02) | |
XB9367586 | XDEA USD SAMSHA (01) |