Healthcare Provider Details

I. General information

NPI: 1134165830
Provider Name (Legal Business Name): BETH ANNE SCHULZ-BUTULIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 SIX FORKS RD STE 211
RALEIGH NC
27609-8228
US

IV. Provider business mailing address

5904 SIX FORKS RD STE 211
RALEIGH NC
27609-8228
US

V. Phone/Fax

Practice location:
  • Phone: 984-242-0510
  • Fax: 984-242-0520
Mailing address:
  • Phone: 984-242-0510
  • Fax: 984-242-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0102201026
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2006-00799
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: