MEDICARE: DR. MUJTABA I BUTT 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	207RG0100X	Gastroenterology Physician	ME116837	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194819474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUJTABA I BUTT M.D.

Provider Business Mailing Address
First Line	:	4800 BELFORT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 KINGSLEY AVE
Second Line	:	SUITE 1101
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4504
Country	:	US
Telephone Number	:	904-264-9797
Fax Number	:	904-264-4644

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/21/2016

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