Provider Demographics
NPI:1528347234
Name:BUTLER, LEROY (DO)
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 WARREN PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4063
Mailing Address - Country:US
Mailing Address - Phone:972-616-4000
Mailing Address - Fax:972-591-6469
Practice Address - Street 1:5575 WARREN PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4063
Practice Address - Country:US
Practice Address - Phone:972-616-4000
Practice Address - Fax:972-591-6469
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3481207XX0004X
NVDO2046207XX0004X
TN34390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1528347234Medicaid
NVV113808Medicare PIN