MEDICARE: DR. WALTER ROBERTSON 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
1	174400000X	Specialist	28012	KY

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	:	1871603886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER ROBERTSON BUTLER M.D.

Provider Business Mailing Address
First Line	:	3430 NEWBURG RD
Second Line	:	SUITE 212
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2497
Country	:	US
Telephone Number	:	502-454-8800
Fax Number	:	502-736-0140

Provider Business Practice Location Address
First Line	:	3430 NEWBURG RD
Second Line	:	SUITE 212
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2497
Country	:	US
Telephone Number	:	502-454-8800
Fax Number	:	502-736-0140

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/19/2015

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