MEDICARE: MR. GERALD L BUTTELWERTH MS, ARNP-BC

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
1	363L00000X	Nurse Practitioner	ARNP 9198184	FL
2	363L00000X	Nurse Practitioner	RN 063105 NP	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U3922Z	OTHER	FL	MEDICARE #

General Provider Information

NPI Number	:	1184605123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD L BUTTELWERTH MS, ARNP-BC

Provider Business Mailing Address
First Line	:	940 PALM DR
Second Line	:
City	:	BELLEAIR BEACH
State	:	FL
Zip	:	33786-3341
Country	:	US
Telephone Number	:	727-596-4530
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 PALM DR
Second Line	:
City	:	BELLEAIR BEACH
State	:	FL
Zip	:	33786-3341
Country	:	US
Telephone Number	:	727-596-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	05/12/2008

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