Healthcare Provider Details

I. General information

NPI: 1134291263
Provider Name (Legal Business Name): CRAIG M BUETTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RICE MINE ROAD LOOP SUITE 206
TUSCALOOSA AL
35406-2414
US

IV. Provider business mailing address

100 RICE MINE ROAD LOOP SUITE 206
TUSCALOOSA AL
35406-2414
US

V. Phone/Fax

Practice location:
  • Phone: 205-339-0171
  • Fax: 205-333-8681
Mailing address:
  • Phone: 205-339-0171
  • Fax: 205-333-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00016599
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: