Individual
JACQUELINE FONTENOT BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2901 N FOURTH ST, EMERGENCY ROOM, LONGVIEW, TX 75605
(903) 758-1818
Mailing address
2901 N FOURTH ST, EMERGENCY ROOM, LONGVIEW, TX 75605
(903) 758-1818
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q2519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2188453
—
LA
Enumeration date
04/09/2012
Last updated
10/21/2019
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