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NPI Code Detail

MEDICARE: DR. STACY COLOMBO BUTLER MD

MEDICARE: DR. STACY COLOMBO BUTLER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianN2037TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18AG791OTHERBC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225246622
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY COLOMBO BUTLER MD
Provider Business Mailing Address
First Line : 2512 OLD TRINITY WAY
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-0517
Country : US
Telephone Number : 817-346-5336
Fax Number : 817-346-5366
Provider Business Practice Location Address
First Line : 6100 HARRIS PKWY STE 140
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4130
Country : US
Telephone Number : 817-346-5336
Fax Number : 817-346-5366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 06/01/2011

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