Ezell, Justin H

Ezell, Justin H is an individual health care provider with primary practice located at 4201 Camp Bowie Blvd , Fort Worth TX 76107-3928. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Ezell, Justin H can be contacted via phone (817) 731-0801.

Contact Information

Primary practice address
4201 Camp Bowie Blvd Fort Worth TX 76107-3928
Phone: (817) 731-0801
Fax: (817) 731-8468
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM 204D00000X BP10057446 Texas
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1068202
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R7207 Texas

Profile Details

NPI number 1740332212
LBN Legal business name Ezell, Justin H
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2007
Last updated Feb 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740332212 NPPES
Texas MEDICAID 291361803
Texas MEDICAID 291361801
Texas MEDICAID 291361802

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