Provider Demographics
NPI:1760724140
Name:BOTWRIGHT, GENE ROBERT JR
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:ROBERT
Last Name:BOTWRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SIX FORKS RD
Mailing Address - Street 2:SUITE 320 ANDERSON PLAZA
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7752
Mailing Address - Country:US
Mailing Address - Phone:910-544-9316
Mailing Address - Fax:
Practice Address - Street 1:100 E SIX FORKS RD
Practice Address - Street 2:SUITE 320 ANDERSON PLAZA
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7752
Practice Address - Country:US
Practice Address - Phone:910-544-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine