Provider Demographics
NPI:1083849566
Name:CAESAR, SCOTT RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RAYMOND
Last Name:CAESAR
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8931 COLONIAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-458-1196
Practice Address - Fax:239-458-1345
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449472208800000X
FLME118670208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1192953OtherMEDICAID-STAYWELL
FLP1020013OtherFREEDOM
FLP959333OtherOPTIMUM
FL4144646OtherAETNA
FL374854OtherAVMED
FL1192953OtherWELLCARE
FL14V78OtherBCBS
FL9701950OtherCIGNA
FLP01807142OtherCLEAR HEALTH ALLIANCE
FLHV360ZMedicare PIN