Provider Demographics
NPI:1427014067
Name:BUTEHORN, HENRY FREDERICK III (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:FREDERICK
Last Name:BUTEHORN
Suffix:III
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:P.O. BOX 5787
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-5787
Mailing Address - Country:US
Mailing Address - Phone:864-582-2900
Mailing Address - Fax:864-582-4991
Practice Address - Street 1:1095 IRON ORE ROAD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2239
Practice Address - Country:US
Practice Address - Phone:864-582-2900
Practice Address - Fax:864-582-4991
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26667207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC26667Medicaid
AA03142961Medicare UPIN