Provider Demographics
NPI:1881691574
Name:BUTCHER, DEWAYNE (MD)
Entity type:Individual
Prefix:
First Name:DEWAYNE
Middle Name:
Last Name:BUTCHER
Suffix:
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NC
Mailing Address - Zip Code:28760-0308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5272
Practice Address - Country:US
Practice Address - Phone:828-681-2146
Practice Address - Fax:828-651-9569
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37801207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920447Medicaid
930119503OtherRAILROAD MEDICARE
930119503OtherRAILROAD MEDICARE
NCC38247Medicare UPIN
NC2146009JMedicare PIN
NC2146009KMedicare PIN