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General NPI Number Information
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NPI Number | 1740604164
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Entity Type | Individual
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Provider Name | TRENTON YOUNGS BUTLER PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1865 LPGA BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7108
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Country | US
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Telephone | 386-255-4596
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Fax | 386-258-3561
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Provider Business Mailing Address
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Address Line | 1865 LPGA BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7108
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Country | US
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Telephone | 386-255-4596
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Fax | 386-258-3561
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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 | PA9107799
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License Number State | FL
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