Provider Demographics
NPI:1730220963
Name:PRICE, CECIL DWIGHT (MD)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:DWIGHT
Last Name:PRICE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7386
Mailing Address - Street 2:WAKE FOREST UNIVERSITY STUDENT HEALTH SERVICE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27109-7386
Mailing Address - Country:US
Mailing Address - Phone:336-758-5218
Mailing Address - Fax:336-758-6054
Practice Address - Street 1:WAKE FOREST UNIVERSITY - 1834 REYNOLDA ROAD
Practice Address - Street 2:MACKIE HEALTH CENTER - REYNOLDS GYMNASIUM - WINGATE RD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-758-5218
Practice Address - Fax:336-758-6054
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NC30846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30846OtherSTATE LICENSE NUMBER
BP0680959OtherDEA NUMBER
C86057Medicare UPIN