Provider Demographics
NPI:1386753325
Name:BUTLER, JONATHAN W (MD, MED)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD, MED
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9615 E 148TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-574-1254
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:17840 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5409
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN26897207Q00000X, 207QA0401X
IN01070077A207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4121708OtherBLUE CROSS BLUE SHILD
TNG27139Medicare UPIN