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General NPI Number Information
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NPI Number | 1255661641
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Entity Type | Individual
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Provider Name | JOHN CARL BUTERBAUGH M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 4609 VICTORIA BEACH WAY
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City | LAS VEGAS
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State | NV
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Zip | 89130-5363
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Country | US
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Telephone | 702-395-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 4609 VICTORIA BEACH WAY
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City | LAS VEGAS
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State | NV
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Zip | 89130-5363
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Country | US
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Telephone | 702-395-0655
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 028125L
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License Number State | PA
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