MEDICARE: IAN J BUTLER M.D.

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	E6739	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139295308	OTHER	TX	CSHCN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	87X553	OTHER	TX	BCBS
4	139295317	OTHER	TX	CSHCN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8U4869	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1184651895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN J BUTLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:	1010
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	832-325-7151
Fax Number	:	713-512-2248

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	11/05/2020

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Directions to “ IAN J BUTLER M.D.” Practice Location

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