Individual
DR. NITIN SANTOSH BUTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
841 PRUDENTIAL DR FL 10, JACKSONVILLE, FL 32207-8329
(904) 394-5404
(904) 391-5545
Mailing address
PO BOX 41113, JACKSONVILLE, FL 32203-1113
(904) 376-3707
(904) 636-5786
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME108771
FL
2084N0600X
Clinical Neurophysiology Physician
ME108771
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0039592-00
—
FL
01
—
P01050785
RR MEDICARE
FL
Enumeration date
06/07/2007
Last updated
01/07/2025
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