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General NPI Number Information
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NPI Number | 1790239150
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Entity Type | Individual
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Provider Name | SAMUEL BUTLER PA-C MPAS
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Gender | Male
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 06/22/2019
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Provider Practice Location Address
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Address Line | 2145 NE 164TH ST APT 632
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4291
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Country | US
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Telephone | 979-216-6079
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 NE 164TH ST APT 632
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4291
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Country | US
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Telephone | 979-216-6079
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10742
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License Number State | TX
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