Provider Demographics
NPI:1730184961
Name:BUTLER, REX ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:ALLEN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 S THREE NOTCH ST
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5321
Mailing Address - Country:US
Mailing Address - Phone:334-222-8525
Mailing Address - Fax:334-222-3566
Practice Address - Street 1:843 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5321
Practice Address - Country:US
Practice Address - Phone:334-222-8525
Practice Address - Fax:334-222-3566
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010420Medicaid
ALC73113Medicare UPIN
AL000010420Medicare ID - Type UnspecifiedMEDICARE NUMBER