Provider Demographics
NPI:1407210792
Name:BUTTERMORE, ALEXANDER
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BUTTERMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 PALM CROSSING DR
Mailing Address - Street 2:APT 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5448
Mailing Address - Country:US
Mailing Address - Phone:954-448-6409
Mailing Address - Fax:
Practice Address - Street 1:3629 PALM CROSSING DR
Practice Address - Street 2:APT 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5448
Practice Address - Country:US
Practice Address - Phone:954-448-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS168641835P0018X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist