Healthcare Provider Details

I. General information

NPI: 1457473597
Provider Name (Legal Business Name): ADRIAN LEE BUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLYMPIC PLAZA CIR STE 600
TYLER TX
75701-1954
US

IV. Provider business mailing address

700 OLYMPIC PLAZA CIR STE 600
TYLER TX
75701-1954
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3488
  • Fax:
Mailing address:
  • Phone: 903-596-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberU1646
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberU1646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: