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General NPI Number Information
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NPI Number | 1740483882
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Entity Type | Individual
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Provider Name | NITIN SANTOSH BUTALA MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 841 PRUDENTIAL DR FL 10
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8329
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Country | US
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Telephone | 904-394-5404
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Fax | 904-391-5545
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Provider Business Mailing Address
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Address Line | PO BOX 41113
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City | JACKSONVILLE
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State | FL
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Zip | 32203-1113
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Country | US
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Telephone | 904-376-3707
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Fax | 904-636-5786
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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 | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | ME108771
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME108771
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License Number State | FL
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