1265419725 NPI number — GILBERT D EZELL MD

Table of content: GILBERT D EZELL MD (NPI 1265419725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265419725 NPI number — GILBERT D EZELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EZELL
Provider First Name:
GILBERT
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265419725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 CHARLOTTE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37209-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-250-9200
Provider Business Mailing Address Fax Number:
615-250-9251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5651 FRIST BLVD
Provider Second Line Business Practice Location Address:
STE 616
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37076-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-391-4394
Provider Business Practice Location Address Fax Number:
615-391-0284
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD16306 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3032279 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340013305 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64791700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005158 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com