Provider Demographics
NPI:1396787230
Name:BUTLER, THOMAS WAYNE (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WAYNE
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:PO BOX 40430
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0430
Mailing Address - Country:US
Mailing Address - Phone:251-665-8000
Mailing Address - Fax:251-665-8010
Practice Address - Street 1:1660 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1405
Practice Address - Country:US
Practice Address - Phone:251-665-8000
Practice Address - Fax:251-665-8010
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11393207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065691Medicaid
AL051544345OtherBCBS
MS05830273Medicaid
TN136553OtherBLUE CROSS
AL009911290Medicaid
TN136553OtherBLUE CROSS
AL009911290Medicaid
TN3065692Medicare ID - Type Unspecified