Provider Demographics
NPI:1568458255
Name:EZZELL, CHAD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DAVID
Last Name:EZZELL
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 1:1850 HICKORY
Mailing Address - Street 2:#101
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:325-670-5740
Mailing Address - Fax:325-670-5744
Practice Address - Street 1:1850 HICKORY
Practice Address - Street 2:#101
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-670-5740
Practice Address - Fax:325-670-5744
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73112Medicare UPIN