MEDICARE: DR. RANDY HITT BUTLER 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	207Q00000X	Family Medicine Physician	6224	NV
2	2083A0100X	Aerospace Medicine Physician	31647	TX

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	:	1609969492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY HITT BUTLER M.D.

Provider Business Mailing Address
First Line	:	653 N TOWN CENTER DR
Second Line	:	SUITE 502
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0514
Country	:	US
Telephone Number	:	702-242-4102
Fax Number	:	702-242-0177

Provider Business Practice Location Address
First Line	:	6125 N CONQUISTADOR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1339
Country	:	US
Telephone Number	:	702-218-0931
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/23/2022

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