| Creative Image Laser Solution | |
|
3661 Hwy 377 South Brownwood TX 76801-5900 | |
| (325) 642-4014 | |
| Not Available |
| Full Name | Creative Image Laser Solution |
|---|---|
| Speciality | Internal Medicine |
| Location | 3661 Hwy 377 South, Brownwood, Texas |
| Authorized Official Name and Position | Gary N Butka (OWNER) |
| Authorized Official Contact | 3256424014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Image Laser Solution 3661 Hwy 377 South Brownwood TX 76801-5900 Ph: (325) 642-4014 | Creative Image Laser Solution 3661 Hwy 377 South Brownwood TX 76801-5900 Ph: (325) 642-4014 |
| NPI Number | 1760664650 |
|---|---|
| Provider Enumeration Date | 12/03/2007 |
| Last Update Date | 11/18/2008 |
| Medicare PECOS PAC ID | 0446324651 |
|---|---|
| Medicare Enrollment ID | O20080806000669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760664650 | NPI | - | NPPES |
| G6479 | Other | TX | TX MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G6479 (Texas) | Primary |
| Provider Name | Gary N Butka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871581272 PECOS PAC ID: 0345159513 Enrollment ID: I20060912000489 |
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