Healthcare Provider Details

I. General information

NPI: 1295626422
Provider Name (Legal Business Name): RYAN BUTRON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5158 ADAIR OAK DR
ORLANDO FL
32829-8223
US

IV. Provider business mailing address

5158 ADAIR OAK DR
ORLANDO FL
32829-8223
US

V. Phone/Fax

Practice location:
  • Phone: 904-274-3588
  • Fax:
Mailing address:
  • Phone: 202-677-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: