Healthcare Provider Details

I. General information

NPI: 1487696688
Provider Name (Legal Business Name): BROWNWOOD SPECIALTY GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 CROCKETT DR
BROWNWOOD TX
76801-5900
US

IV. Provider business mailing address

2502 CROCKETT DR
BROWNWOOD TX
76801-5900
US

V. Phone/Fax

Practice location:
  • Phone: 325-643-5521
  • Fax:
Mailing address:
  • Phone: 325-643-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG6479
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK2249
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL3615
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE1026
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number643131
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0955
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2503
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number706322
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD4147
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number606438
License Number StateTX
# 11
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number587449
License Number StateTX

VIII. Authorized Official

Name: DR. GARY N BUTKA
Title or Position: OWNER
Credential: M.D.
Phone: 325-643-5521