Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A111303 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A111303 | CA |
N | 207NS0135X | Procedural Dermatology | A111303 | CA |
NPI | 1013118843 |
---|---|
Provider Name | Susan Tosh Butler |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Carlos, CA 94070-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 09/10/2020 |