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NPI 1629594957

IndividualActive

Jack Butler

NPI 1629594957 · Driver · Wise, VA

Provider details

NPI number: 1629594957
Entity type: Individual
Primary specialty: DriverOther Service Providers
Sex: Male
Sole proprietor: No

Specialties & taxonomies

DriverPrimary172A00000X
Other Service Providers

Practice location

5401 Pole Bridge Rd

Wise, VA 24293-4333

Phone: (276) 328-1712

Approximate (ZIP-level) locationGet directions

More VA providers

Mailing address

5401 Pole Bridge Rd

Wise, VA 24293-4333

Registry dates

Enumerated: 2017-08-18
Last updated: 2022-07-21

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Jack Butler — NPI 1629594957, Wise, VA | NPI Central