Healthcare Provider Details

I. General information

NPI: 1952345811
Provider Name (Legal Business Name): DAVID M. BUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 300
SANTA MONICA CA
90404-2087
US

IV. Provider business mailing address

1301 20TH ST SUITE 300
SANTA MONICA CA
90404-2050
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-7792
  • Fax: 310-829-4136
Mailing address:
  • Phone: 310-829-7792
  • Fax: 310-829-4136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG44732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG44732
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG44732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: