Healthcare Provider Details

I. General information

NPI: 1972775559
Provider Name (Legal Business Name): CHRISTINA MARIE BUTLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SUMMIT DR
CORBIN KY
40701-2746
US

IV. Provider business mailing address

57 SUMMIT DR
CORBIN KY
40701-2746
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-9700
  • Fax: 606-528-8423
Mailing address:
  • Phone: 606-528-9700
  • Fax: 606-528-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41670
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: