Provider Demographics
NPI:1285091256
Name:BUTLER, MANDELL JOSEPH JR (NP)
Entity type:Individual
Prefix:MR
First Name:MANDELL
Middle Name:JOSEPH
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:469-291-2841
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5959 HARRY HINES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9087
Practice Address - Country:US
Practice Address - Phone:214-645-8600
Practice Address - Fax:214-645-8631
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA08612363LF0000X
TXAP131614363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX556574YKP5Medicare PIN