1003279779 NPI number — WILLIAM TYLER CECIL D.O.

Table of content: WILLIAM TYLER CECIL D.O. (NPI 1003279779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003279779 NPI number — WILLIAM TYLER CECIL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CECIL
Provider First Name:
WILLIAM
Provider Middle Name:
TYLER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003279779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WAKE FOREST SCHOOL OF MEDICINE
Provider Second Line Business Mailing Address:
DEPT OF PSYCHIATRY, MEDICAL CENTER BLVD
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27157-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-4551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY
Provider Second Line Business Practice Location Address:
791 JONESTOWN ROAD
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-4551
Provider Business Practice Location Address Fax Number:
336-716-9642
Provider Enumeration Date:
03/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  2021-01923 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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