MEDICARE: DR. RUSSELL JAMES BUTTERFIELD MD/PHD

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	60198221205	UT

General Provider Information

NPI Number	:	1639352321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL JAMES BUTTERFIELD MD/PHD

Provider Business Mailing Address
First Line	:	PO BOX 413027
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3027
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-1103
Country	:	US
Telephone Number	:	801-585-6387
Fax Number	:

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	11/11/2021

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