Provider Demographics
NPI:1366631749
Name:EZMAN, ALFRED THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:THOMAS
Last Name:EZMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1773
Mailing Address - Country:US
Mailing Address - Phone:864-488-1514
Mailing Address - Fax:864-488-0552
Practice Address - Street 1:211 W MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1773
Practice Address - Country:US
Practice Address - Phone:864-488-1514
Practice Address - Fax:864-488-0552
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH60957Medicare UPIN