Provider Demographics
NPI:1073519450
Name:GONZALEZ, MICHAEL BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRYAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5197
Mailing Address - Country:US
Mailing Address - Phone:828-433-4484
Mailing Address - Fax:828-433-4487
Practice Address - Street 1:111 HILLTOP ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671-0620
Practice Address - Country:US
Practice Address - Phone:828-874-4293
Practice Address - Fax:828-874-2357
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4455597OtherAETNA
NC89134RNMedicaid
NC12 01558OtherUNITED HEALTHCARE
NCC8954OtherMEDCOST
NC134RNOtherBCBS OF NC
NCC8954OtherMEDCOST