Provider Demographics
NPI:1841488582
Name:CHAD D. EZZELL, M.D., PA
Entity type:Organization
Organization Name:CHAD D. EZZELL, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:EZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-670-5740
Mailing Address - Street 1:1850 HICKORY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2334
Mailing Address - Country:US
Mailing Address - Phone:325-670-5740
Mailing Address - Fax:325-670-5744
Practice Address - Street 1:1850 HICKORY ST STE 105
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2334
Practice Address - Country:US
Practice Address - Phone:325-670-5740
Practice Address - Fax:325-670-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4928207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH73112Medicare UPIN