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Individual

GLORIA J BUTLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2200 HIGHWAY 61 N, VICKSBURG, MS 39183-8246
(601) 883-3340
Mailing address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10669
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0010931
MS
05
1994014
LA
01
4251157
BCBS
MS
01
5968106
AETNA
MS
Enumeration date
07/05/2006
Last updated
09/10/2020
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