Provider Demographics
NPI:1548848823
Name:BUTLER, JULIAN ROBERT
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:ROBERT
Last Name:BUTLER
Suffix:
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 1:4943 PARK RD UNIT 606
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3853
Mailing Address - Country:US
Mailing Address - Phone:763-458-1259
Mailing Address - Fax:
Practice Address - Street 1:1940 WEST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208
Practice Address - Country:US
Practice Address - Phone:980-402-1660
Practice Address - Fax:980-402-1661
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC303170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine