Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA04683900 | NJ |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 25MA04683900 | NJ |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 25MA04683900 | NJ |
NPI | 1063417905 |
---|---|
Provider Name | Mark S Butler |
First Address | Somerset, NJ 08873-1369 |
Second Address | Somerset, NJ 08873-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 15/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E53607 | (02) | NJ |