Healthcare Provider Details

I. General information

NPI: 1861452831
Provider Name (Legal Business Name): EDGARDO GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2043
US

IV. Provider business mailing address

48 PATTON PL
ASHEVILLE NC
28805-1623
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax: 828-299-5992
Mailing address:
  • Phone: 828-298-7911
  • Fax: 828-299-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9339
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: