Provider Demographics
NPI:1730510900
Name:BUTZ, PAM (LAC, MSOM)
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:144 SILVER MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:PILOT
Mailing Address - State:VA
Mailing Address - Zip Code:24138-1703
Mailing Address - Country:US
Mailing Address - Phone:540-651-2682
Mailing Address - Fax:540-651-2682
Practice Address - Street 1:144 SILVER MAPLE LN
Practice Address - Street 2:
Practice Address - City:PILOT
Practice Address - State:VA
Practice Address - Zip Code:24138-1703
Practice Address - Country:US
Practice Address - Phone:540-651-2682
Practice Address - Fax:540-651-2682
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000750171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist