Provider Demographics
NPI:1265419725
Name:EZELL, GILBERT D (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:D
Last Name:EZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2801 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4035
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:615-250-9251
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:STE 616
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-391-4394
Practice Address - Fax:615-391-0284
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2016-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD16306208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3032279Medicaid
TN340013305OtherRR MEDICARE
KY64791700Medicaid
TN2005158OtherBLUE CROSS
TN340013305OtherRR MEDICARE