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General NPI Number Information
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NPI Number | 1205801107
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Entity Type | Individual
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Provider Name | WAYNE MITCHELL BUTLER PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 740 HIGH ST SUITE 2001
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3102
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Country | US
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Telephone | 570-321-3165
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Fax | 570-321-3166
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone | 888-647-9600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA000270L
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License Number State | PA
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