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General NPI Number Information
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NPI Number | 1649430430
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Entity Type | Individual
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Provider Name | KHAYREE BUTLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2008
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 2222 NW LOVEJOY ST STE 601
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City | PORTLAND
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State | OR
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Zip | 97210-5104
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Country | US
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Telephone | 503-413-5514
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Fax | 503-413-5594
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Provider Business Mailing Address
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Address Line | PO BOX 3777
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City | PORTLAND
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State | OR
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Zip | 97208-3777
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Country | US
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Telephone | 503-413-3900
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Fax | 503-413-3710
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TRN12927
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | MD178228
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License Number State | OR
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