Healthcare Provider Details

I. General information

NPI: 1871569269
Provider Name (Legal Business Name): EZECHIEL R. NEHUS, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N QUANAH AVE
RUSSELLVILLE AR
72801-2762
US

IV. Provider business mailing address

200 N QUANAH AVE
RUSSELLVILLE AR
72801-2762
US

V. Phone/Fax

Practice location:
  • Phone: 479-890-0368
  • Fax: 479-890-7368
Mailing address:
  • Phone: 479-890-0368
  • Fax: 479-890-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EZECHIEL R. NEHUS
Title or Position: OWNER
Credential: MD
Phone: 479-890-0368