Individual
BENNETT J. EZEKIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 SCENIC DR STE 1108, GEORGETOWN, TX 78626-7724
(512) 400-4195
(512) 287-5563
Mailing address
PO BOX 674029, DALLAS, TX 75267-4029
(512) 400-4195
(512) 287-5563
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
N6287
TX
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
N6287
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
N6287
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282030002
—
TX
05
—
282030003
—
TX
Enumeration date
11/15/2007
Last updated
02/17/2020
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