Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00017240 | WA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD00017240 | WA |
NPI | 1194775510 |
---|---|
Provider Name | Michael Butler |
First Address | Bremerton, WA 98310-4203 |
Second Address | Bremerton, WA 98310-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 30/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080006439 | RAILROAD MEDICARE (01) | |
4324384 | AETNA (01) | |
75424 | LABOR & INDUSTRIES (01) | WA |
8178105 | (05) | WA |
8915346 | CRIME VICTIMS COMP (01) | WA |
A06899 | (02) | |
AB8818176 | DEA (01) | |
BU8932 | REGENCE BLUE SHIELD (01) |