Basic Information
| Provider Information | |||||||||
| NPI: | 1578556510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 N HIGH ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038397440 | ||||||||
| FaxNumber: | 8555160354 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 N HIGH ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038397440 | ||||||||
| FaxNumber: | 8555160354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 10261 | NV | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 49393 | CO | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | 10261 | NV | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0203X | 49393 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.