Provider Demographics
NPI:1578782264
Name:EZE, ALEXANDER O (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:O
Last Name:EZE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BROADWAY ST
Mailing Address - Street 2:BOX 262295
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4704
Mailing Address - Country:US
Mailing Address - Phone:713-939-0666
Mailing Address - Fax:713-939-0674
Practice Address - Street 1:9713 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-9025
Practice Address - Country:US
Practice Address - Phone:713-939-0666
Practice Address - Fax:713-939-0674
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177915901Medicaid