Healthcare Provider Details

I. General information

NPI: 1770756595
Provider Name (Legal Business Name): ALEXANDRA MILLOFF BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

IV. Provider business mailing address

PO BOX 278
WOODBURN OR
97071-0278
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-2042
  • Fax: 503-413-2566
Mailing address:
  • Phone: 971-983-5260
  • Fax: 971-983-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME109315
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD170971
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: