Basic Information
| Provider Information | |||||||||
| NPI: | 1083015887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W CENTER STREET PROMENADE STE 300 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928053960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144494841 | ||||||||
| FaxNumber: | 7149376233 | ||||||||
| Practice Location | |||||||||
| Address1: | 1621 W IMOLA AVE | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945594721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072514280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN170793 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | NP95006240 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | RN170793 | 01 | GA | GA LICENSE | OTHER |