Basic Information
| Provider Information | |||||||||
| NPI: | 1215996772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTTERWORTH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | F | ||||||||
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| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E BROAD ST | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY, BOX 980695 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048282207 | ||||||||
| FaxNumber: | 8048288300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 E BROAD ST | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY, BOX 980695 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048282207 | ||||||||
| FaxNumber: | 8048288300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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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 | 207L00000X | 0101031080 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200523620 | 05 | IN | MEDICAID |