Healthcare Provider Details

I. General information

NPI: 1265896526
Provider Name (Legal Business Name): GARY TYLER BUTTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SPRING HILL AVE
MOBILE AL
36604-1407
US

IV. Provider business mailing address

2451 FILLINGIM ST., RES BOX 7TH FLOOR
MOBILE AL
36617
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-1200
  • Fax: 251-435-6357
Mailing address:
  • Phone: 251-471-7207
  • Fax: 251-471-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36631
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: