Provider Demographics
NPI:1174521264
Name:BUTLER, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6511 DEER POINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-546-8037
Mailing Address - Fax:410-546-8038
Practice Address - Street 1:6511 DEER POINTE DRIVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-546-8037
Practice Address - Fax:410-546-8038
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005940207W00000X, 207WX0107X
MDD0055876207W00000X, 207WX0107X
MDD-0055876207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001091501Medicaid
MD803600400Medicaid
MDG92903Medicare UPIN
G92903Medicare UPIN
DE0001091501Medicaid