Healthcare Provider Details

I. General information

NPI: 1265724553
Provider Name (Legal Business Name): WILLIAM JASON BUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE DEPT OF SURGERY
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278-8275
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone: 760-830-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA122410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101258761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: