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General NPI Number Information
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NPI Number | 1043267578
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Entity Type | Organization
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Legal Business Name | BUTLER FAMILY PRACTICE
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Dates
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Enumeration Date | 05/29/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 116 WOODY DR
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City | BUTLER
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State | PA
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Zip | 16001-5692
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Country | US
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Telephone | 724-287-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 116 WOODY DR
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City | BUTLER
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State | PA
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Zip | 16001-5692
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Country | US
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Telephone | 724-287-8500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK A CARLSSON
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Credential | M.D.
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Telephone | 724-287-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029584E
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License Number State | PA
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