Healthcare Provider Details

I. General information

NPI: 1427088830
Provider Name (Legal Business Name): FREDERICK BUTLER II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 WITMER STREET
LOS ANGELES CA
90017-2395
US

IV. Provider business mailing address

2550 NORTH HOLLYWOOD WAY SUITE 209
BURBANK CA
91505-5019
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-2423
  • Fax: 213-202-7028
Mailing address:
  • Phone: 818-557-0135
  • Fax: 818-557-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA73853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: