Basic Information
| Provider Information | |||||||||
| NPI: | 1639100928 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BUTLER | ||||||||
| FirstName: | JAVED | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 N STATE STREET | ||||||||
| Address2: | DEPT OF CARDIOLOGY | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019846426 | ||||||||
| FaxNumber: | 6019846439 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019841000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 31361 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 26174 | MS | Y |
ID Information
| ID | Type | State | Issuer | Description | 083484803A | 05 | GA | MEDICAID | 3836286 | 05 | TN | MEDICAID | 64722093 | 05 | KY | MEDICAID |