Provider Demographics
NPI:1285613190
Name:SENTER, CEDRIC HALE (MD)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:HALE
Last Name:SENTER
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 1:19200 SPACE CENTER BLVD
Mailing Address - Street 2:APT 1111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3736
Mailing Address - Country:US
Mailing Address - Phone:281-480-8248
Mailing Address - Fax:
Practice Address - Street 1:2101 NASA PKWY
Practice Address - Street 2:SD2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3607
Practice Address - Country:US
Practice Address - Phone:281-483-2593
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK4575Medicaid
NMK4575Medicaid