Provider Demographics
NPI:1770129710
Name:JOHN, EZE
Entity type:Individual
Prefix:MR
First Name:EZE
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 SLICK ROCK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1470
Mailing Address - Country:US
Mailing Address - Phone:508-410-0512
Mailing Address - Fax:
Practice Address - Street 1:9894 BISSONNET ST STE 875
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8371
Practice Address - Country:US
Practice Address - Phone:508-410-0512
Practice Address - Fax:281-783-6558
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNO NUMBER AVAILABLE AT THIS TIME