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Individual

PAMELA S BUTCHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
645 KANAWHA AVE, RAINELLE, WV 25962-1013
(304) 438-6188
(304) 438-6819
Mailing address
645 KANAWHA AVE, RAINELLE, WV 25962-1013
(304) 438-6188
(304) 438-6819

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1829
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1713064
BC/BS
WV
05
1802427000
WV
01
7652215
AETNA
WV
01
80190394
RR MEDICARE
WV
01
H22519
TRICARE
WV
Enumeration date
08/30/2005
Last updated
08/27/2012
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