Provider Demographics
NPI:1538260385
Name:BUTCHER, PEARLINE M (DO)
Entity type:Individual
Prefix:DR
First Name:PEARLINE
Middle Name:M
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3603
Mailing Address - Country:US
Mailing Address - Phone:615-361-5669
Mailing Address - Fax:
Practice Address - Street 1:341 WALLACE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8000
Practice Address - Country:US
Practice Address - Phone:615-690-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDO697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1270303Medicaid
TN1270303Medicaid