Provider Demographics
NPI:1407893027
Name:INES, CAESAR S (MD)
Entity Type:Individual
Prefix:
First Name:CAESAR
Middle Name:S
Last Name:INES
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 1:91-1053 HOKUIKEKAI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:623-252-7790
Mailing Address - Fax:808-597-8781
Practice Address - Street 1:9225 N 3RD ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2439
Practice Address - Country:US
Practice Address - Phone:602-870-6316
Practice Address - Fax:602-870-6091
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35044207P00000X
HIMD 10688207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112303Medicaid
AZ112303Medicaid
AZZ110018Medicare PIN