Dr Jerry Guwayne Ezell, DDS is a medicare enrolled "Dentist - General Practice" provider in Tallulah, Louisiana. His current practice location is
1403 Johnson St, Tallulah, Louisiana. You can reach out to his office (for appointments etc.) via phone at
(318) 574-0765.
Dr Jerry Guwayne Ezell is licensed to practice in Louisiana (license number 4479) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1720153729.
Healthcare Provider's Profile
Full Name | Dr Jerry Guwayne Ezell |
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Gender | Male |
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Speciality | Dentist - General Practice |
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Location | 1403 Johnson St, Tallulah, Louisiana |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1720153729
- Provider Enumeration Date: 11/22/2006
- Last Update Date: 09/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 8123328762
- Enrollment ID: I20151203001355
Medical Identifiers
Medical identifiers for Dr Jerry Guwayne Ezell such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1720153729 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1223G0001X | Dentist - General Practice | 4479 (Louisiana) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jerry Guwayne Ezell is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Jerry Guwayne Ezell, DDS 1403 Johnson St, Tallulah, LA 71282-5513 Ph: (318) 574-0765 | Dr Jerry Guwayne Ezell, DDS 1403 Johnson St, Tallulah, LA 71282-5513 Ph: (318) 574-0765 |
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