Provider Demographics
NPI:1306876826
Name:BUTLER, CLINT CHACHERE (MD)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:CHACHERE
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 1:926 FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71038-6100
Mailing Address - Country:US
Mailing Address - Phone:318-624-0554
Mailing Address - Fax:318-624-3782
Practice Address - Street 1:926 FRANCES DR
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-6100
Practice Address - Country:US
Practice Address - Phone:318-624-0554
Practice Address - Fax:318-624-3782
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1493929Medicaid
LA5A185B579Medicare PIN
LAG68933Medicare UPIN
LA5A185C739Medicare Oscar/Certification
LA1493929Medicaid
LA5A185B579Medicare Oscar/Certification
LA5A185C739Medicare PIN
LA5A185CM42Medicare PIN
LA5A185DB47Medicare PIN