Healthcare Provider Details

I. General information

NPI: 1376807354
Provider Name (Legal Business Name): IAN ANTHONY BUTLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAILEY AVE
NEEDLES CA
92363-3198
US

IV. Provider business mailing address

PO BOX 21471
BULLHEAD CITY AZ
86439-1471
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-7100
  • Fax: 760-459-2208
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13133
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: