MEDICARE: DR. ROBERT RANDOLPH BUTTS PSY.D.

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
1	103TC0700X	Clinical Psychologist	PY0004732	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265451462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT RANDOLPH BUTTS PSY.D.

Provider Business Mailing Address
First Line	:	6333 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1703
Country	:	US
Telephone Number	:	727-548-6100
Fax Number	:	727-545-0960

Provider Business Practice Location Address
First Line	:	6333 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1703
Country	:	US
Telephone Number	:	727-548-6100
Fax Number	:	727-545-0960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	01/20/2012

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