Healthcare Provider Details

I. General information

NPI: 1578668711
Provider Name (Legal Business Name): EDWARD JAMES BUJOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 HICKORY BLVD
GRANITE FALLS NC
28630-0965
US

IV. Provider business mailing address

PO BOX 965 4132 HICKORY BLVD
GRANITE FALLS NC
28630-0965
US

V. Phone/Fax

Practice location:
  • Phone: 828-396-4028
  • Fax: 828-396-8783
Mailing address:
  • Phone: 828-396-4028
  • Fax: 828-396-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29829
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: