Provider Demographics
NPI:1427088830
Name:BUTLER, FREDERICK II (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:BUTLER
Suffix:II
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 1:2550 NORTH HOLLYWOOD WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5019
Mailing Address - Country:US
Mailing Address - Phone:818-557-0135
Mailing Address - Fax:818-557-1394
Practice Address - Street 1:616 WITMER STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2395
Practice Address - Country:US
Practice Address - Phone:213-977-2423
Practice Address - Fax:213-202-7028
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73853207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A738530Medicaid
CA00A738530OtherBLUE SHIELD
CA00A738530Medicaid
CA00A738530OtherBLUE SHIELD