Healthcare Provider Details

I. General information

NPI: 1316943236
Provider Name (Legal Business Name): MARCUS A BUTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S 9TH ST
CANON CITY CO
81212-4911
US

IV. Provider business mailing address

715 S 9TH ST
CANON CITY CO
81212-4911
US

V. Phone/Fax

Practice location:
  • Phone: 719-269-8820
  • Fax: 719-204-0230
Mailing address:
  • Phone: 719-269-8820
  • Fax: 719-204-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38223
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: