MEDICARE: DR. GENE ROBERT BOTWRIGHT JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36462	NC

General Provider Information

NPI Number	:	1760724140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENE ROBERT BOTWRIGHT JR.

Provider Business Mailing Address
First Line	:	100 E SIX FORKS RD
Second Line	:	SUITE 320 ANDERSON PLAZA
City	:	RALEIGH
State	:	NC
Zip	:	27609-7752
Country	:	US
Telephone Number	:	910-544-9316
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E SIX FORKS RD
Second Line	:	SUITE 320 ANDERSON PLAZA
City	:	RALEIGH
State	:	NC
Zip	:	27609-7752
Country	:	US
Telephone Number	:	910-544-9316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	03/22/2013

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