Individual
WALTER BLAKE BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 W 4TH ST, SUITE 310, COOKEVILLE, TN 38501-2448
(931) 528-7877
(931) 526-3261
Mailing address
100 W 4TH ST, SUITE 310, COOKEVILLE, TN 38501-2448
(931) 528-7877
(931) 526-3261
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
39755
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3332331
—
TN
01
—
4106662
BCBS
TN
05
—
64125958
—
KY
01
—
P00362930
MEDICARE RAILROAD
TN
Enumeration date
12/30/2005
Last updated
07/13/2010
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