MEDICARE: MARIE SMITH BUTLER

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	246RP1900X	Phlebotomy Technician	CPT-01006336	CA

General Provider Information

NPI Number	:	1477407559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE SMITH BUTLER

Provider Business Mailing Address
First Line	:	4719 QUAIL LAKES DR.
Second Line	:	SUITE G /#1176
City	:	STOCKTON
State	:	CA
Zip	:	95207
Country	:	US
Telephone Number	:	408-816-9500
Fax Number	:	408-816-9500

Provider Business Practice Location Address
First Line	:	1942 CALHOUN WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-4004
Country	:	US
Telephone Number	:	408-816-9500
Fax Number	:

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

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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