Provider Demographics
NPI:1821030834
Name:GONZALEZ, ANNE RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:RICARDO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:915 TATE BLVD SE
Mailing Address - Street 2:STE 170
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-345-0800
Mailing Address - Fax:828-345-0350
Practice Address - Street 1:915 TATE BLVD SE
Practice Address - Street 2:STE 170
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4012
Practice Address - Country:US
Practice Address - Phone:828-345-0800
Practice Address - Fax:828-345-0350
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200300473207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2015833Medicare PIN
NCH83792Medicare UPIN