Healthcare Provider Details

I. General information

NPI: 1952664773
Provider Name (Legal Business Name): ANDREW R BUTCHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DIANA DR
WEBSTER SPRINGS WV
26288-9078
US

IV. Provider business mailing address

125 DIANA DR
WEBSTER SPRINGS WV
26288-9078
US

V. Phone/Fax

Practice location:
  • Phone: 304-847-5682
  • Fax: 681-342-2500
Mailing address:
  • Phone: 304-847-5682
  • Fax: 681-342-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2809
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: