Basic Information
| Provider Information | |||||||||
| NPI: | 1124087226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5246 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066100246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843873 | ||||||||
| FaxNumber: | 2033843829 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 MILL HILL AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066102811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843873 | ||||||||
| FaxNumber: | 2033843829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 09/09/2015 | ||||||||
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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 | 208600000X | 033726 | CT | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 001337262 | 05 | CT | MEDICAID |