Healthcare Provider Details

I. General information

NPI: 1013116987
Provider Name (Legal Business Name): RICHARD JASON BUTLER CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 QUINCY AVE
BROCKTON MA
02302-2803
US

IV. Provider business mailing address

790 W CHESTNUT ST
BROCKTON MA
02301-5513
US

V. Phone/Fax

Practice location:
  • Phone: 508-587-7300
  • Fax: 866-837-9923
Mailing address:
  • Phone: 508-587-7300
  • Fax: 508-587-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: