Provider Demographics
NPI:1134165830
Name:SCHULZ-BUTULIS, BETH ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANNE
Last Name:SCHULZ-BUTULIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5904 SIX FORKS RD STE 211
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8228
Mailing Address - Country:US
Mailing Address - Phone:984-242-0510
Mailing Address - Fax:984-242-0520
Practice Address - Street 1:5904 SIX FORKS RD STE 211
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8228
Practice Address - Country:US
Practice Address - Phone:984-242-0510
Practice Address - Fax:984-242-0520
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201026174400000X
NC2006-00799207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCK037D895OtherMEDICARE PTAN
P01533825OtherRAILROAD MEDICARE PTAN