Provider Demographics
NPI:1043428634
Name:BUTTARS, RUSSELL JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JAY
Last Name:BUTTARS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2561 S 1560 W STE B
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2361
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:2310 N 400 E STE A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1796
Practice Address - Country:US
Practice Address - Phone:435-787-2000
Practice Address - Fax:435-787-1913
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE 4727213ES0103X
CAEL 1582213ES0103X
UT11633905-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery