Provider Demographics
NPI:1215119235
Name:BUTLER, CLIFTON DA CARLOS (PA-C)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:DA CARLOS
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1721 ADMIRAL TAUSSIG BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-2802
Mailing Address - Country:US
Mailing Address - Phone:757-953-8897
Mailing Address - Fax:
Practice Address - Street 1:1721 ADMIRAL TAUSSIG BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2802
Practice Address - Country:US
Practice Address - Phone:757-953-8897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2024-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110006618363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant