Provider Demographics
NPI:1447709639
Name:CHEW, CECIL RAY JR
Entity type:Individual
Prefix:MR
First Name:CECIL
Middle Name:RAY
Last Name:CHEW
Suffix:JR
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 1:5 FALCON CT APT 4
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4425
Mailing Address - Country:US
Mailing Address - Phone:501-482-8716
Mailing Address - Fax:
Practice Address - Street 1:5 FALCON CT APT 4
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-4425
Practice Address - Country:US
Practice Address - Phone:501-482-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR909998411171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171M00000XOtherCASE MANAGER/ CARE COORDINATOR