Basic Information
| Provider Information | |||||||||
| NPI: | 1477646917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 MEDICAL PKWY | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124540392 | ||||||||
| FaxNumber: | 5124541233 | ||||||||
| Practice Location | |||||||||
| Address1: | 4315 JAMES CASEY ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787453365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124447944 | ||||||||
| FaxNumber: | 5124447946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 11/13/2012 | ||||||||
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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 | 207Y00000X | K5842 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 88691J | 01 | BCBS | OTHER | 8517930 | 05 | WA | MEDICAID | 100911002 | 05 | TX | MEDICAID |