Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | E4337 | AR |
NPI | 1912973306 |
---|---|
Provider Name | Mr. Ezechiel R. Nehus |
First Address | Russellville, AR 72801-2762 |
Second Address | Russellville, AR 72801-2762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 04/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156412001 | (05) | AR |
5N221 | ARKANSAS BCBS (01) | AR |
I32480 | (02) | AR |