Provider Demographics
NPI:1114025459
Name:BUTLER, SHERRI M (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3034
Mailing Address - Country:US
Mailing Address - Phone:801-918-0181
Mailing Address - Fax:
Practice Address - Street 1:332 S ORCHARD SPRINGS DR STE 150
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007
Practice Address - Country:US
Practice Address - Phone:719-253-7640
Practice Address - Fax:719-253-7644
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48225841205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72073713Medicaid