Basic Information
| Provider Information | |||||||||
| NPI: | 1770574451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CECALUPO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067758600 | ||||||||
| FaxNumber: | 8067758602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | F3427 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0207X | F3427 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8P8412 | 01 | TX | HMO BLUE | OTHER | J004 | 01 | NM | TRIWEST | OTHER | 8C0182 | 01 | TX | BCBS | OTHER | 14976366 | 05 | NM | MEDICAID | 8G6054 | 01 | TX | BC/BS | OTHER | 88932 | 05 | NM | MEDICAID | 88932 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER |