Provider Demographics
NPI:1912973306
Name:NEHUS, EZECHIEL R (MD)
Entity Type:Individual
Prefix:MR
First Name:EZECHIEL
Middle Name:R
Last Name:NEHUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N QUANAH AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2762
Mailing Address - Country:US
Mailing Address - Phone:479-890-0368
Mailing Address - Fax:479-890-7368
Practice Address - Street 1:200 N QUANAH AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2762
Practice Address - Country:US
Practice Address - Phone:479-890-0368
Practice Address - Fax:479-890-7368
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4337207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N221OtherARKANSAS BCBS
AR156412001Medicaid
ARI32480Medicare UPIN
AR5N221Medicare ID - Type Unspecified