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General NPI Number Information
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NPI Number | 1295129369
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Entity Type | Individual
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Provider Name | JACOB LOUIS EZELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1619 N COLLEGE AVE UNIT 1
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1752
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Country | US
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Telephone | 317-459-1862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.132189
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0002216264
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 35.132189
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License Number State | OH
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