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NPI Code Detail

MEDICARE: DR. DOUGLAS T. EZELL M.D.

MEDICARE: DR. DOUGLAS T. EZELL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician4623MT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3160029899OTHERMTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710912514
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS T. EZELL M.D.
Provider Business Mailing Address
First Line : 1611 ZIMMERMAN TRL
Second Line :
City : BILLINGS
State : MT
Zip : 59102-7652
Country : US
Telephone Number : 406-248-3607
Fax Number : 406-248-8919
Provider Business Practice Location Address
First Line : 1611 ZIMMERMAN TRL
Second Line :
City : BILLINGS
State : MT
Zip : 59102-7652
Country : US
Telephone Number : 406-248-3607
Fax Number : 406-248-8919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 05/07/2009

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