Provider Demographics
NPI:1891995247
Name:VERONICA WELLS BUTLER MD PC
Entity type:Organization
Organization Name:VERONICA WELLS BUTLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-683-3101
Mailing Address - Street 1:1221 N COURT
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1909
Mailing Address - Country:US
Mailing Address - Phone:641-683-3101
Mailing Address - Fax:641-683-3029
Practice Address - Street 1:1221 N COURT
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1909
Practice Address - Country:US
Practice Address - Phone:641-683-3101
Practice Address - Fax:641-683-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1020206Medicaid