Provider Demographics
NPI:1053601849
Name:CECIL, JULIAN
Entity type:Individual
Prefix:
First Name:JULIAN
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 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:580-336-9411
Mailing Address - Fax:
Practice Address - Street 1:1318 ELM ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5034
Practice Address - Country:US
Practice Address - Phone:580-336-9411
Practice Address - Fax:580-336-9422
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28661207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine