Healthcare Provider Details

I. General information

NPI: 1336841030
Provider Name (Legal Business Name): TAYLOR LEE BUTTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21065 POWERLINE RD STE 2A
BOCA RATON FL
33433-2311
US

IV. Provider business mailing address

21065 POWERLINE RD STE 2A
BOCA RATON FL
33433-2311
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-6632
  • Fax:
Mailing address:
  • Phone: 561-652-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS23770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: