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NPI Code Detail

MEDICARE: TINA M BUTLER P.A-C

MEDICARE: TINA M BUTLER P.A-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA02260TX

General Provider Information

NPI Number : 1154417202
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA M BUTLER P.A-C
Provider Business Mailing Address
First Line : PO BOX 4232
Second Line :
City : ODESSA
State : TX
Zip : 79760-4232
Country : US
Telephone Number : 432-580-5891
Fax Number : 432-582-2302
Provider Business Practice Location Address
First Line : 500 E 4TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-5110
Country : US
Telephone Number : 432-580-8686
Fax Number : 432-582-2302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/09/2007

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Directions to “ TINA M BUTLER P.A-C” Practice Location

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