Provider Demographics
NPI:1588693568
Name:BUTLER, ROSE M (DPM)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NEXT
Other - Middle Name:STEP
Other - Last Name:PODIATRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11031
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-1031
Mailing Address - Country:US
Mailing Address - Phone:417-224-1224
Mailing Address - Fax:417-413-2773
Practice Address - Street 1:2057 N MARION AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1934
Practice Address - Country:US
Practice Address - Phone:417-224-1224
Practice Address - Fax:417-413-2773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001020002213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001013909Medicare ID - Type Unspecified
MOU87912Medicare UPIN