Provider Demographics
NPI:1053352500
Name:BUTLER, LARRY S (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3213 SUMMIT SQUARE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2636
Mailing Address - Country:US
Mailing Address - Phone:859-381-1066
Mailing Address - Fax:859-263-0650
Practice Address - Street 1:3213 SUMMIT SQUARE PL
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2636
Practice Address - Country:US
Practice Address - Phone:859-381-1066
Practice Address - Fax:859-263-0650
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY20759207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000290311OtherANTHEM
KY64207590Medicaid
KYC81576Medicare UPIN
KY64207590Medicaid