Provider Demographics
NPI:1548250392
Name:CECCOLI, HECTOR D (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:D
Last Name:CECCOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1783 TROUP HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5869
Mailing Address - Country:US
Mailing Address - Phone:903-595-2283
Mailing Address - Fax:903-595-1063
Practice Address - Street 1:1783 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5869
Practice Address - Country:US
Practice Address - Phone:903-595-2283
Practice Address - Fax:903-595-1063
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9749207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1635235Medicaid
TX87791YOtherBCBS OF TEXAS
TXP00268149OtherPALMETTO GBA
TX096567503Medicaid
TXP00268149OtherPALMETTO GBA
TX8D6108Medicare ID - Type Unspecified