Provider Demographics
NPI:1487243598
Name:BUTTRESS, RON
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:BUTTRESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3135
Mailing Address - Country:US
Mailing Address - Phone:918-912-2026
Mailing Address - Fax:918-912-2029
Practice Address - Street 1:1006 N YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3135
Practice Address - Country:US
Practice Address - Phone:918-694-5270
Practice Address - Fax:918-682-9606
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK933237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist