Provider Demographics
NPI:1770574451
Name:CECALUPO, ANTHONY J (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:CECALUPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-8600
Practice Address - Fax:806-775-8602
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3427208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P8412OtherHMO BLUE
NMJ004OtherTRIWEST
TX8C0182OtherBCBS
NM14976366Medicaid
TX8G6054OtherBC/BS
NM88932Medicaid
NM88932OtherPRESBYTERIAN COMMERCIAL
NM88932Medicaid
NMJ004OtherTRIWEST
NM88932OtherPRESBYTERIAN COMMERCIAL