Provider Demographics
NPI:1851632806
Name:EZELL, JOSHUA E (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:E
Last Name:EZELL
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 1:5701 W 119TH ST STE 145
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3749
Mailing Address - Country:US
Mailing Address - Phone:913-491-6633
Mailing Address - Fax:
Practice Address - Street 1:5701 W 119TH ST STE 145
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3749
Practice Address - Country:US
Practice Address - Phone:913-491-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011989207R00000X
OH34.011988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126683Medicaid
OH0126683Medicaid