Provider Demographics
NPI:1568475713
Name:BUTLER, EARL R JR (MD)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:R
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:131 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRANDVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-288-5402
Mailing Address - Fax:864-234-7961
Practice Address - Street 1:131 COMMONWEALTH DR
Practice Address - Street 2:SUITE 310
Practice Address - City:GRANDVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-288-5402
Practice Address - Fax:864-234-7961
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2981Medicaid
E69256Medicare UPIN