Healthcare Provider Details

I. General information

NPI: 1073577185
Provider Name (Legal Business Name): JAMES F. BUTTKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL SUITE B260A
SIERRA VISTA AZ
85635-2967
US

IV. Provider business mailing address

77 CALLE PORTAL SUITE B260A
SIERRA VISTA AZ
85635-2967
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-9751
  • Fax: 520-515-9786
Mailing address:
  • Phone: 520-515-9751
  • Fax: 520-515-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13713
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13713
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: