Individual
MR. OLIVER LAURENCE EZELL
Active
Individual
MR. OLIVER LAURENCE EZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-234
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630477348034
TRICARE
AL
01
—
7722482
AETNA
AL
01
—
P20387
HEALTHSPRING/SENIORS 1ST
AL
Enumeration date
06/01/2005
Last updated
10/30/2007
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