Individual
GORDON BUTZIRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
601 SE WASHINGTON ST, IDABEL, OK 74745-3319
(580) 286-6688
(580) 286-6699
Mailing address
601 SE WASHINGTON ST, IDABEL, OK 74745-3319
(580) 286-6688
(580) 286-6699
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA45
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OK
Enumeration date
08/05/2006
Last updated
09/03/2015
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