Healthcare Provider Details

I. General information

NPI: 1053362426
Provider Name (Legal Business Name): MICHAEL RAY BUTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BOSWELL ST
LEXINGTON TN
38351-1566
US

IV. Provider business mailing address

PO BOX 5009
BRENTWOOD TN
37024-5009
US

V. Phone/Fax

Practice location:
  • Phone: 731-968-2006
  • Fax: 731-968-9970
Mailing address:
  • Phone: 615-221-1400
  • Fax: 615-221-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45522
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAB8216841
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50780
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: