Provider Demographics
NPI:1497831630
Name:EZELL, ROBERT FLOYD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FLOYD
Last Name:EZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEEST FREEWAY
Mailing Address - Street 2:SUITE #328
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-771-0495
Mailing Address - Fax:713-995-4618
Practice Address - Street 1:7777 SOUTHWEEST FREEWAY
Practice Address - Street 2:SUITE #328
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-771-0495
Practice Address - Fax:713-995-4618
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B22958Medicare UPIN
00N982Medicare PIN