Healthcare Provider Details

I. General information

NPI: 1053632034
Provider Name (Legal Business Name): IAN B BUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 WARING CT STE D
OCEANSIDE CA
92056-4510
US

IV. Provider business mailing address

3231 WARING CT STE D
OCEANSIDE CA
92056-4510
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-0221
  • Fax: 760-941-0905
Mailing address:
  • Phone: 760-941-0221
  • Fax: 760-941-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberH5896
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC137716
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD439803
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD439803
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: