Healthcare Provider Details

I. General information

NPI: 1497942494
Provider Name (Legal Business Name): JOE BUTLER JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 HARBOR BLVD SUITE 309
PORT CHARLOTTE FL
33952-5317
US

IV. Provider business mailing address

2525 HARBOR BLVD SUITE 309
PORT CHARLOTTE FL
33952-5317
US

V. Phone/Fax

Practice location:
  • Phone: 941-629-7597
  • Fax: 941-629-5070
Mailing address:
  • Phone: 941-629-7597
  • Fax: 941-629-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 39536
License Number StateFL

VIII. Authorized Official

Name: DR. JOE BUTLER JR.
Title or Position: DOCTOR
Credential: MD
Phone: 941-629-7597