Individual
MR. JESSE PAUL BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-4340
(217) 784-2360
Mailing address
2514 VILLAGE GREEN PL, CHAMPAIGN, IL 61822-7675
(773) 321-2800
(773) 321-2801
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-094206
IL
207XS0117X
Orthopaedic Surgery of the Spine Physician
036-094206
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL3794001
MEDICARE PTAN
IL
Enumeration date
05/16/2006
Last updated
05/30/2024
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