Provider Demographics
NPI:1174514228
Name:BUTLER, STEVEN C (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2002 BROOKSIDE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4634
Mailing Address - Country:US
Mailing Address - Phone:423-245-6000
Mailing Address - Fax:423-245-6062
Practice Address - Street 1:2002 BROOKSIDE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-245-6000
Practice Address - Fax:423-245-6062
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN021779207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6002048Medicaid
TN3063437Medicaid
TN165323OtherBLUE CROSS BLUE SHIELD
TN850101OtherJOHN DEERE HEALTH
TN165323OtherBLUE CROSS BLUE SHIELD
F01004Medicare UPIN
TN850101OtherJOHN DEERE HEALTH