Individual
MR. JACK D BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3300 NW EXPRESSWAY, OKLAHOMA CITY, OK 73112-4418
(405) 713-7403
(405) 713-2794
Mailing address
5300 N INDEPENDENCE AVE, STE 280, OKLAHOMA CITY, OK 73112-5556
(405) 713-7403
(405) 713-2794
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1786
AZ
207R00000X
Internal Medicine Physician
Primary
2084
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240010
—
AZ
Enumeration date
01/09/2006
Last updated
07/20/2017
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