Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | ME0038116 | FL |
Y | 2084N0402X | Child Neurologist | ME38116 | FL |
NPI | 1255490652 |
---|---|
Provider Name | Kenneth A Butler |
First Address | Miami, FL 33155-4071 |
Second Address | Palmetto Bay, FL 33157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056882100 | (05) | FL |
D63570 | (02) |