Provider Demographics
NPI:1841811957
Name:CECIL, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:CECIL
Suffix:
Gender:M
Credentials:
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 1789
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1789
Mailing Address - Country:US
Mailing Address - Phone:281-346-3480
Mailing Address - Fax:
Practice Address - Street 1:516 TENNESSEE ST STE 233
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4717
Practice Address - Country:US
Practice Address - Phone:281-346-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic