Individual
TERRY H EZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1780 MEDICAL PARK DR, ROCK HILL, SC 29732-1194
(803) 327-1116
(803) 327-6872
Mailing address
9735 KINCEY AVE, SUITE 201, HUNTERSVILLE, NC 28078-9118
(704) 414-2870
(704) 414-2860
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
17708
SC
208800000X
Urology Physician
95-00570
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005525006
AETNA
SC
01
—
136H3
BCBS OF NC
NC
05
—
177089
—
SC
01
—
1905786
UNITED HEALTHCARE
SC
01
—
279866
MAMSI
SC
01
—
57365
MEDCOST
SC
01
—
760694
GREAT WEST
SC
05
—
89136H3
—
NC
Enumeration date
11/17/2006
Last updated
03/31/2015
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