Basic Information
| Provider Information | |||||||||
| NPI: | 1770756595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | MILLOFF | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 278 | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970710278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719835260 | ||||||||
| FaxNumber: | 9719835326 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 N GANTENBEIN AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034132042 | ||||||||
| FaxNumber: | 5034132566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME109315 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD170971 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 003749200 | 05 | FL | MEDICAID | 500689081 | 05 | OR | MEDICAID |