Provider Demographics
NPI:1134282411
Name:DELEON, CESAR R (DO)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:R
Last Name:DELEON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE-FRANK RD N STE A100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5663
Practice Address - Country:US
Practice Address - Phone:239-430-2520
Practice Address - Fax:239-430-2522
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00186494OtherRRMC
FL52161OtherBCBS
H11985Medicare UPIN
FL521612Medicare ID - Type Unspecified