Provider Demographics
NPI:1871603886
Name:BUTLER, WALTER ROBERTSON (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ROBERTSON
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2497
Mailing Address - Country:US
Mailing Address - Phone:502-454-8800
Mailing Address - Fax:502-736-0140
Practice Address - Street 1:3430 NEWBURG RD
Practice Address - Street 2:SUITE 212
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2497
Practice Address - Country:US
Practice Address - Phone:502-454-8800
Practice Address - Fax:502-736-0140
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100102210Medicaid
KY7100102210Medicaid
KYF13424Medicare UPIN