Healthcare Provider Details

I. General information

NPI: 1770129710
Provider Name (Legal Business Name): MR. EZE JOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 BISSONNET ST STE 875
HOUSTON TX
77036-8371
US

IV. Provider business mailing address

11530 SLICK ROCK DR
RICHMOND TX
77406-1470
US

V. Phone/Fax

Practice location:
  • Phone: 508-410-0512
  • Fax: 281-783-6558
Mailing address:
  • Phone: 508-410-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: