Provider Demographics
NPI:1629188354
Name:GAZZOLA, LUIZ RENATO (MD)
Entity Type:Individual
Prefix:
First Name:LUIZ
Middle Name:RENATO
Last Name:GAZZOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIZ
Other - Middle Name:RENATO ALMEIDA
Other - Last Name:GAZZOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:302 NEW PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1162
Mailing Address - Country:US
Mailing Address - Phone:919-933-9403
Mailing Address - Fax:
Practice Address - Street 1:300 VEAZEY DR
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1668
Practice Address - Country:US
Practice Address - Phone:919-764-2223
Practice Address - Fax:919-764-5198
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97009642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97176Medicare UPIN