Healthcare Provider Details

I. General information

NPI: 1598401580
Provider Name (Legal Business Name): GAVIN BARRY BUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 INDIANA AVE
WINSLOW AZ
86047-2169
US

IV. Provider business mailing address

500 INDIANA AVE
WINSLOW AZ
86047-2169
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4646
  • Fax:
Mailing address:
  • Phone: 928-289-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberU6210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: