Provider Demographics
NPI:1194752246
Name:BUTLER, ROBERT ALLEN II (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:BUTLER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 WILBURN WAY
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3693
Mailing Address - Country:US
Mailing Address - Phone:662-323-9908
Mailing Address - Fax:662-323-8948
Practice Address - Street 1:101 WILBURN WAY
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3693
Practice Address - Country:US
Practice Address - Phone:662-323-9908
Practice Address - Fax:662-323-8948
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025028207X00000X
MS19062207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08259096Medicaid
MSH41939Medicare UPIN
MS200000508Medicare ID - Type Unspecified