Individual
MR. LARRY DON EZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 ECOLLEGE STREET, HOMER, LA 71040
(318) 927-2024
(318) 927-3723
Mailing address
620 ECOLLEGE STREET, HOMER, LA 71040
(318) 927-2024
(318) 927-3723
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
C7023
AR
207Q00000X
Family Medicine Physician
Primary
C7023
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112238001
—
AR
05
—
1884219
—
LA
01
—
50503
BLUE SHIELD
AR
01
—
MD203522
LOUISIANA LICENSE
LA
Enumeration date
05/10/2006
Last updated
03/13/2014
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