Provider Demographics
NPI:1538186010
Name:BUTLER, PHILLIP MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3478
Mailing Address - Street 2:DEPARTMENT A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-3478
Mailing Address - Country:US
Mailing Address - Phone:918-494-9288
Mailing Address - Fax:918-494-9289
Practice Address - Street 1:6485 S YALE
Practice Address - Street 2:SUITE 1200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-494-9288
Practice Address - Fax:918-494-9289
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK12518207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34464Medicare UPIN