Healthcare Provider Details

I. General information

NPI: 1538460506
Provider Name (Legal Business Name): CHRISTOPHER FRANCIS BUTHORN RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5046 HIGHWAY 17 BYP S STE 103
MYRTLE BEACH SC
29588
US

IV. Provider business mailing address

35 GREEN POND RD STE C
ROCKAWAY NJ
07866-2057
US

V. Phone/Fax

Practice location:
  • Phone: 843-668-4104
  • Fax: 843-668-4108
Mailing address:
  • Phone: 973-625-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2531
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: