Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01070077A | IN |
N | 207Q00000X | Family Doctor | 26897 | TN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 26897 | TN |
NPI | 1386753325 |
---|---|
Provider Name | Jonathan W Butler |
First Address | Noblesville, IN 46060-5409 |
Second Address | Noblesville, IN 46060-5409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 26/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4121708 | BLUE CROSS BLUE SHILD (01) | TN |
G27139 | (02) | TN |