Provider Demographics
NPI:1447274832
Name:HUSTON, BUTCH MAYNER (MD)
Entity type:Individual
Prefix:DR
First Name:BUTCH
Middle Name:MAYNER
Last Name:HUSTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3960 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE LL21
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2569
Mailing Address - Country:US
Mailing Address - Phone:763-236-9050
Mailing Address - Fax:
Practice Address - Street 1:3960 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE LL21
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2569
Practice Address - Country:US
Practice Address - Phone:763-236-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN41929207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology