Provider Demographics
NPI:1578668711
Name:BUJOLD, EDWARD JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JAMES
Last Name:BUJOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:4132 HICKORY BLVD
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-0965
Mailing Address - Country:US
Mailing Address - Phone:828-396-4028
Mailing Address - Fax:828-396-8783
Practice Address - Street 1:4132 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-0965
Practice Address - Country:US
Practice Address - Phone:828-396-4028
Practice Address - Fax:828-396-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344390OtherMEDICARE PTAN GROUP
NC19642OtherBC
NC8919642Medicaid
C81961Medicare UPIN