Healthcare Provider Details

I. General information

NPI: 1639154495
Provider Name (Legal Business Name): JACK BUTTERFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 S MAIN ST
ROSEVILLE OH
43777-1284
US

IV. Provider business mailing address

860 BETHESDA DR
ZANESVILLE OH
43701-1800
US

V. Phone/Fax

Practice location:
  • Phone: 740-697-7373
  • Fax: 740-697-7683
Mailing address:
  • Phone: 740-454-4651
  • Fax: 740-454-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35045078
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: