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NPI Code Detail

MEDICARE: JASON ROBERT BUTLER M.D.

MEDICARE:   JASON ROBERT 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
1207Q00000XFamily Medicine PhysicianN0671TX
2208VP0014XInterventional Pain Medicine PhysicianN0671TX
3207QS0010XSports Medicine (Family Medicine) PhysicianN0671TX

General Provider Information

NPI Number : 1710142484
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON ROBERT BUTLER M.D.
Provider Business Mailing Address
First Line : 74 REGENCY PKWY
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-0951
Country : US
Telephone Number : 817-419-6111
Fax Number : 817-419-9582
Provider Business Practice Location Address
First Line : 74 REGENCY PKWY
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-7816
Country : US
Telephone Number : 817-419-6111
Fax Number : 817-419-9582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2008
Last Update Date : 02/20/2024

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