Provider Demographics
NPI:1699760769
Name:ASKEW, EZELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:EZELL
Middle Name:
Last Name:ASKEW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S FAIRMONT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5106
Mailing Address - Country:US
Mailing Address - Phone:209-603-9217
Mailing Address - Fax:209-594-1665
Practice Address - Street 1:801 S FAIRMONT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5106
Practice Address - Country:US
Practice Address - Phone:209-603-9217
Practice Address - Fax:209-594-1665
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-072085R0204X, 2085R0202X
CAA90462208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM302618Medicare PIN
COCO301164Medicare PIN