Provider Demographics
NPI:1407044829
Name:ENNIS, CECIL LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:LAWRENCE
Last Name:ENNIS
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 1:750 MORPHY AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE, AL 36523
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-928-2375
Mailing Address - Fax:
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-928-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7000225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner