MEDICARE: DAVID ALLEN BUTLER D.O.

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	2057	WV
2	208M00000X	Hospitalist Physician	OS10915	FL
3	207Q00000X	Family Medicine Physician	OS10915	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001859054	OTHER	BLUE CROSS/BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639127996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN BUTLER D.O.

Provider Business Mailing Address
First Line	:	2400 HARBOR BLVD STE 4
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5038
Country	:	US
Telephone Number	:	941-629-3500
Fax Number	:	941-629-3100

Provider Business Practice Location Address
First Line	:	2400 HARBOR BLVD STE 4
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5038
Country	:	US
Telephone Number	:	941-629-3500
Fax Number	:	941-629-3100

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/13/2024

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Directions to “ DAVID ALLEN BUTLER D.O.” Practice Location

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