MEDICARE: DR. CAROLYN M BUTTROSS M.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	2080P0006X	Developmental - Behavioral Pediatrics Physician	06016	MS

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	:	1558400770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN M BUTTROSS M.D

Provider Business Mailing Address
First Line	:	2112 BIENVILLE BLVD
Second Line	:	SUITE G
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3052
Country	:	US
Telephone Number	:	228-872-7705
Fax Number	:	228-872-7746

Provider Business Practice Location Address
First Line	:	2112 BIENVILLE BLVD
Second Line	:	SUITE G
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3052
Country	:	US
Telephone Number	:	228-872-7705
Fax Number	:	228-872-7746

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/09/2007

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