Doctor Name: | DR. IVAN LEWIS BUTLER |
NPI Number: | 1184995797 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD028571L |
Business Practice Address: | 204 St. Charles Way Unit 364e York, PA - 17402 |
Business Phone Number: | 7178454208 |
Business Fax Number: | 7178465958 |
Mailing Address: | 204 St. Charles Way, Unit 364e YORK |
State: | PA |
Postal Code: | 17402 |
Phone Number: | 7178454208 |
Fax Number: | 7178465958 |
NPI Enumeration Date: | 01/13/2012 |
NPI Last Update Date: | 01/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD028571L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |