Provider Demographics
NPI:1366419715
Name:BUTLER, STEPHEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:1601 W TIMBERLANE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566
Practice Address - Country:US
Practice Address - Phone:813-708-1312
Practice Address - Fax:813-443-8147
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61505208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265754600Medicaid
FLE61452Medicare UPIN
FL14586XMedicare PIN