Healthcare Provider Details

I. General information

NPI: 1437447794
Provider Name (Legal Business Name): ALI EZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLOSSOM ST
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

PO BOX 58538
WEBSTER TX
77598-8538
US

V. Phone/Fax

Practice location:
  • Phone: 832-632-6500
  • Fax: 409-772-9532
Mailing address:
  • Phone: 281-724-7341
  • Fax: 281-724-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberQ8470
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301091774
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberQ8470
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ8470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: