Provider Demographics
NPI:1497778575
Name:OPHELAN, CESAR AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTO
Last Name:OPHELAN
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 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE 514
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-558-4035
Mailing Address - Fax:305-826-0724
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 514
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-558-4035
Practice Address - Fax:305-826-0724
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32185207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21463Medicare UPIN
30226Medicare ID - Type Unspecified