MEDICARE: DR. DAVID LEE BUTLER PH.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	103G00000X	Clinical Neuropsychologist	PY4064	FL
2	103T00000X	Psychologist	PY4064	FL
3	103TB0200X	Cognitive & Behavioral Psychologist	PY4064	FL
4	103TC0700X	Clinical Psychologist	PY4064	FL
5	103TF0200X	Forensic Psychologist	PY4064	FL
6	103TR0400X	Rehabilitation Psychologist	PY4064	FL

General Provider Information

NPI Number	:	1417014069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEE BUTLER PH.D.

Provider Business Mailing Address
First Line	:	1835 NE MIAMI GARDENS DR
Second Line	:	#316
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-5035
Country	:	US
Telephone Number	:	704-640-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 NE MIAMI GARDENS DR
Second Line	:	#316
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-5035
Country	:	US
Telephone Number	:	704-640-3264
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/13/2008

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