Organization
COSMETIC IMAGE LASER SOLUTION, LLC
Active
Other names
Creative Image Laser Solution
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY N BUTKA M.D. (OWNER)
(325) 642-4014
Entity
Organization
Contact information
Practice address
3661 HWY 377 SOUTH, BROWNWOOD, TX 76801-5900
(325) 642-4014
Mailing address
3661 HWY 377 SOUTH, BROWNWOOD, TX 76801-5900
(325) 642-4014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G6479
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G6479
TX MEDICAL LICENSE
TX
Enumeration date
12/03/2007
Last updated
11/18/2008
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