Individual
CHARLES EZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2704 W OXFORD LOOP, SUITE 117, OXFORD, MS 38655-5714
(662) 550-4299
(662) 580-4324
Mailing address
2704 W OXFORD LOOP, SUITE 117, OXFORD, MS 38655-5714
(662) 550-4299
(662) 580-4324
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R880502
MS
Other
Enumeration date
08/31/2015
Last updated
08/31/2015
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