Provider Demographics
NPI:1154403426
Name:BUTLER, DAREL A (MD)
Entity type:Individual
Prefix:DR
First Name:DAREL
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2113
Mailing Address - Country:US
Mailing Address - Phone:713-947-3100
Mailing Address - Fax:
Practice Address - Street 1:4141 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2113
Practice Address - Country:US
Practice Address - Phone:713-947-3100
Practice Address - Fax:713-947-6103
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD277522084N0400X
TXT61042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516597Medicaid
TN1516597Medicaid
TN103I137019Medicare PIN