Provider Demographics
NPI:1194729962
Name:BUTLER-LEWIS, RENEE J (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:J
Last Name:BUTLER-LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4411 THE 25 WAY NE
Mailing Address - Street 2:STE 150
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5888
Mailing Address - Country:US
Mailing Address - Phone:505-332-6900
Mailing Address - Fax:505-332-6921
Practice Address - Street 1:4411 THE 25 WAY NE
Practice Address - Street 2:STE 150
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5888
Practice Address - Country:US
Practice Address - Phone:505-332-6900
Practice Address - Fax:505-332-6921
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM97-1952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML0634Medicaid
NM45138Medicaid
NMQ3666Medicaid
NM2258272OtherMEDICARE GROUP
NM52713Medicaid
NMG55236Medicare UPIN
NM52713Medicaid