Provider Demographics
NPI:1487997185
Name:EZEKIEL, CLINTON JOHN (MD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:JOHN
Last Name:EZEKIEL
Suffix:
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 1:301 FISHER STREET
Mailing Address - Street 2:INTERNAL MEDICINE CLINIC
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:228-376-0577
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER STREET
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-0577
Practice Address - Fax:228-376-0103
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine