=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609089432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER N BUTLER, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 543 FONTAINE ST STE A
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-476-3223
-----------------------------------------------------
Fax | 850-476-1948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 543 FONTAINE ST STE A
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-476-3223
-----------------------------------------------------
Fax | 850-476-1948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PETER N BUTLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 850-476-3223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME85312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------