Healthcare Provider Details

I. General information

NPI: 1609969492
Provider Name (Legal Business Name): RANDY HITT BUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/23/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 N CONQUISTADOR ST
LAS VEGAS NV
89149-1339
US

IV. Provider business mailing address

653 N TOWN CENTER DR SUITE 502
LAS VEGAS NV
89144-0514
US

V. Phone/Fax

Practice location:
  • Phone: 702-218-0931
  • Fax:
Mailing address:
  • Phone: 702-242-4102
  • Fax: 702-242-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6224
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number31647
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: