Healthcare Provider Details

I. General information

NPI: 1215924667
Provider Name (Legal Business Name): AMJAD I BUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AMJAD BUTT MD

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK PL
SELMA AL
36701-6764
US

IV. Provider business mailing address

101 PARK PL
SELMA AL
36701-6764
US

V. Phone/Fax

Practice location:
  • Phone: 334-526-2200
  • Fax: 334-526-2220
Mailing address:
  • Phone: 334-526-2200
  • Fax: 334-526-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number38037
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: