Healthcare Provider Details

I. General information

NPI: 1033403522
Provider Name (Legal Business Name): RENESHA CHRISTINE BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENESHA CHRISTINE BUTLER MD

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PRESTON RD
PLANO TX
75024-3214
US

IV. Provider business mailing address

7601 PRESTON RD
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-9250
  • Fax: 214-456-1240
Mailing address:
  • Phone: 214-456-9250
  • Fax: 214-456-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ0612
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: