Basic Information
| Provider Information | |||||||||
| NPI: | 1174514228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 BROOKSIDE DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376604634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232456000 | ||||||||
| FaxNumber: | 4232456062 | ||||||||
| Practice Location | |||||||||
| Address1: | 2002 BROOKSIDE DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376604634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232456000 | ||||||||
| FaxNumber: | 4232456062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 021779 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 6002048 | 05 | VA | MEDICAID | 3063437 | 05 | TN | MEDICAID | 165323 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 850101 | 01 | TN | JOHN DEERE HEALTH | OTHER |