Individual
DR. WIFREDO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
288 S. RIDGECREST AVENUE, RUTHERFORDTON, NC 28139
(828) 286-5420
(706) 731-5289
Mailing address
P.O. BOX 3864, AUGUSTA, GA 30914-3864
(706) 737-4575
(706) 731-5289
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
00035342
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036209
AETNA
—
01
—
1194833855
NPI - RUTHERFORD ANESTH
—
01
—
36179
BLUE SHIELD
NC
01
—
5781203
AETNA
—
01
—
83095
MEDCOST
—
05
—
8936179
—
NC
Enumeration date
09/05/2006
Last updated
06/21/2012
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