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General NPI Number Information
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NPI Number | 1043547102
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Entity Type | Organization
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Legal Business Name | JOHN BOTTSFORD
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 385 SERPENTINE DR STE B
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City | SPARTANBURG
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State | SC
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Zip | 29303-3018
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Country | US
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Telephone | 864-560-7042
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Fax | 864-560-7084
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Provider Business Mailing Address
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Address Line | 385 SERPENTINE DR STE B
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City | SPARTANBURG
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State | SC
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Zip | 29303-3018
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Country | US
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Telephone | 864-560-7042
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Fax | 864-560-7084
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN EUGENE BOTTSFORD JR.
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Credential | MD
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Telephone | 864-560-7042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 6941
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License Number State | SC
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