Provider Demographics
NPI:1427245489
Name:BUTLER, BLAKE A (MD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4800 HOSPITAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-6906
Mailing Address - Country:US
Mailing Address - Phone:402-228-4236
Mailing Address - Fax:402-228-4668
Practice Address - Street 1:4800 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-6906
Practice Address - Country:US
Practice Address - Phone:402-228-4236
Practice Address - Fax:402-228-4668
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2013-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE17094208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE087562Medicare UPIN