Provider Demographics
NPI:1306945795
Name:BUTLER, FREDERICK CLARENCE JR (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CLARENCE
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 RESTON CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6170
Mailing Address - Country:US
Mailing Address - Phone:910-395-9326
Mailing Address - Fax:910-395-0198
Practice Address - Street 1:3749 RESTON CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6170
Practice Address - Country:US
Practice Address - Phone:910-395-9326
Practice Address - Fax:910-395-0198
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13071207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920438Medicaid
NCC83088Medicare UPIN
NC8920438Medicaid