MEDICARE: DR. BRYON G BUTTS DPM

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	213E00000X	Podiatrist	006106	NY

General Provider Information

NPI Number	:	1720192875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYON G BUTTS DPM

Provider Business Mailing Address
First Line	:	36 W 44TH ST
Second Line	:	SUITE 1216
City	:	NEW YORK
State	:	NY
Zip	:	10036-7406
Country	:	US
Telephone Number	:	212-768-0012
Fax Number	:	212-768-0168

Provider Business Practice Location Address
First Line	:	36 W 44TH ST
Second Line	:	SUITE 1216
City	:	NEW YORK
State	:	NY
Zip	:	10036-8102
Country	:	US
Telephone Number	:	212-768-0012
Fax Number	:	212-768-0168

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/15/2014

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