Healthcare Provider Details

I. General information

NPI: 1831246842
Provider Name (Legal Business Name): JEFFREY L BUTTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37131 INTERSTATE 10 W SUITE 101
BOERNE TX
78006-8989
US

IV. Provider business mailing address

37131 INTERSTATE 10 W SUITE 101
BOERNE TX
78006-8989
US

V. Phone/Fax

Practice location:
  • Phone: 830-249-8400
  • Fax: 830-255-4660
Mailing address:
  • Phone: 830-249-8400
  • Fax: 830-255-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberH7939
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: