Individual
JAY BRAD V BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11782 SW BARNES RD, STE 300, PORTLAND, OR 97225-5914
(503) 214-5200
(503) 906-6613
Mailing address
11782 SW BARNES RD, STE 300, PORTLAND, OR 97225-5914
(503) 214-5200
(503) 906-6613
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD19035
OR
207Q00000X
Family Medicine Physician
MD19035
OR
207X00000X
Orthopaedic Surgery Physician
Primary
MD19035
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128384
—
OR
01
—
MD19035
MEDICAL LICENSE
OR
Enumeration date
07/27/2006
Last updated
11/10/2021
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