MEDICARE: STEVEN JOSEPH BUTDORF MD

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	207Q00000X	Family Medicine Physician	MD14039	OR

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

General Provider Information

NPI Number	:	1386696995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN JOSEPH BUTDORF MD

Provider Business Mailing Address
First Line	:	147 S 52ND PL
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-6210
Country	:	US
Telephone Number	:	541-746-1166
Fax Number	:	541-746-6736

Provider Business Practice Location Address
First Line	:	147 S 52ND PL
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-6210
Country	:	US
Telephone Number	:	541-746-1166
Fax Number	:	541-746-6736

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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