Provider Demographics
NPI:1821168154
Name:CECIL, JOHN T JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:CECIL
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:PO BOX 14252
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4035
Mailing Address - Country:US
Mailing Address - Phone:270-575-1010
Mailing Address - Fax:270-575-1018
Practice Address - Street 1:2670 NEW HOLT RD STE C
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7506
Practice Address - Country:US
Practice Address - Phone:270-575-1010
Practice Address - Fax:270-575-1018
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20932208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64209323Medicaid
KYG12472Medicare UPIN
KY64209323Medicaid