Individual
EZRA LEE MCCONNELL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
557 SANDHURST DR, FAYETTEVILLE, NC 28304-4433
(910) 484-8114
(910) 484-1564
Mailing address
557 SANDHURST DR, FAYETTEVILLE, NC 28304-4433
(910) 484-8114
(910) 484-1564
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
9600077
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8956756
—
NC
Enumeration date
07/21/2005
Last updated
01/21/2011
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