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General NPI Number Information
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NPI Number | 1174559819
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Entity Type | Organization
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Legal Business Name | J DOUGLAS BUTLER ADVANCED SURGERY CTR PA
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 295 STONER AVE STE 105
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City | WESTMINSTER
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State | MD
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Zip | 21157-5698
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Country | US
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Telephone | 410-848-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 295 STONER AVE STE 105
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City | WESTMINSTER
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State | MD
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Zip | 21157-5698
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Country | US
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Telephone | 410-848-6800
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN DOUGLAS BUTLER
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Credential | DPM
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Telephone | 410-848-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1299
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License Number State | MD
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