Provider Demographics
NPI:1497496020
Name:BUTTROSS, JOHN BOUSTANY JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BOUSTANY
Last Name:BUTTROSS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6799 GREAT OAKS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2584
Mailing Address - Country:US
Mailing Address - Phone:901-821-8300
Mailing Address - Fax:901-259-9793
Practice Address - Street 1:6799 GREAT OAKS RD STE 105&250
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-2588
Practice Address - Country:US
Practice Address - Phone:901-821-8300
Practice Address - Fax:901-259-9793
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2025-07-01
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Provider Licenses
StateLicense IDTaxonomies
TN72369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty