MEDICARE: DR. JACK BUTTERFIELD 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	35045078	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080002140	OTHER	OH	MEDICARE RAILROAD
3	CA1586	OTHER		GROUP MEDICARE RAILROAD
7	BU0499444	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000019419	OTHER	OH	ANTHEM PIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000177535	OTHER	OH	UNISON PIN
6	311413469030	OTHER	OH	CARESOURCE PIN
8	0197989	OTHER	OH	UHC PIN
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639154495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK BUTTERFIELD M.D.

Provider Business Mailing Address
First Line	:	860 BETHESDA DR
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-1800
Country	:	US
Telephone Number	:	740-454-4651
Fax Number	:	740-454-4653

Provider Business Practice Location Address
First Line	:	167 S MAIN ST
Second Line	:
City	:	ROSEVILLE
State	:	OH
Zip	:	43777-1284
Country	:	US
Telephone Number	:	740-697-7373
Fax Number	:	740-697-7683

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	08/19/2008

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Directions to “ DR. JACK BUTTERFIELD M.D.” Practice Location

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