Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 56824 | SC |
NPI | 1013972132 |
---|---|
Provider Name | Henry Frederick Butehorn JR. |
First Address | Spartanburg, SC 29303-4201 |
Second Address | Spartanburg, SC 29303-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056824 | (05) | SC |