Provider Demographics
NPI:1285635698
Name:AGTARAP, CESAR OCAMPO (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:OCAMPO
Last Name:AGTARAP
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 1:1550 HIGHWAY 15 S
Mailing Address - Street 2:SUITE 80
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-7247
Mailing Address - Country:US
Mailing Address - Phone:606-693-0343
Mailing Address - Fax:606-693-0322
Practice Address - Street 1:1550 HIGHWAY 15 S
Practice Address - Street 2:SUITE 80
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-7247
Practice Address - Country:US
Practice Address - Phone:606-693-0343
Practice Address - Fax:606-693-0322
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1306047105OtherNPI
KY6431-4974Medicaid
KY6431-4974Medicaid
KYG09855Medicare UPIN