MEDICARE: MR. TIMOTHY L BUTTON RPA C

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	363A00000X	Physician Assistant	3695	NY
2	363A00000X	Physician Assistant	003695	NY

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	:	1639166192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY L BUTTON RPA C

Provider Business Mailing Address
First Line	:	789 PRE EMPYION RD
Second Line	:	SUITE 600
City	:	GENEVA
State	:	NY
Zip	:	14456
Country	:	US
Telephone Number	:	315-230-5646
Fax Number	:	315-230-5645

Provider Business Practice Location Address
First Line	:	789 PRE-EMPTION RD
Second Line	:	SUITE 600
City	:	GENEVA
State	:	NY
Zip	:	14456
Country	:	US
Telephone Number	:	315-230-5646
Fax Number	:	315-230-5645

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	06/29/2023

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