MEDICARE: MR. TROY WAYNE 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	172A00000X	Driver	800454987	TX

General Provider Information

NPI Number	:	1487987194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TROY WAYNE BUTLER

Provider Business Mailing Address
First Line	:	6503 HARMON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2108
Country	:	US
Telephone Number	:	281-449-7685
Fax Number	:

Provider Business Practice Location Address
First Line	:	6503 HARMON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2108
Country	:	US
Telephone Number	:	281-449-7685
Fax Number	:

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

Provider Enumeration Date	:	09/13/2009
Last Update Date	:	09/13/2009

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