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General NPI Number Information
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NPI Number | 1053551739
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Entity Type | Organization
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Legal Business Name | JIMMY L EZELL MEDICAL CORP
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 7500 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-2429
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Country | US
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Telephone | 323-971-2250
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Fax | 323-971-5605
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Provider Business Mailing Address
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Address Line | 7500 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-2429
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Country | US
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Telephone | 323-971-2250
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Fax | 323-971-5605
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIMMY L EZELL
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Credential | M.D
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Telephone | 323-971-2250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | C27187
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License Number State | CA
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