Provider Demographics
NPI:1902950538
Name:BUTLER, JENIFER I (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:I
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENIFER
Other - Middle Name:I
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1555 SOQUEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065
Mailing Address - Country:US
Mailing Address - Phone:831-475-1111
Mailing Address - Fax:831-535-1568
Practice Address - Street 1:1555 SOQUEL DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065
Practice Address - Country:US
Practice Address - Phone:831-475-1111
Practice Address - Fax:831-535-1568
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92881207Q00000X, 208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine