Healthcare Provider Details

I. General information

NPI: 1841254158
Provider Name (Legal Business Name): ERNEST BLAKE FAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HENDERSONVILLE RD
ASHEVILLE NC
28803
US

IV. Provider business mailing address

119 HENDERSONVILLE RD
ASHEVILLE NC
28803-2868
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-0670
  • Fax: 828-257-4738
Mailing address:
  • Phone: 828-258-0670
  • Fax: 828-257-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9900829
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: