Provider Demographics
NPI:1528367117
Name:AGUIRRE, CESAR IAN (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:IAN
Last Name:AGUIRRE
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 1:9889 GATE PKWY N BLDG 200
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9228
Mailing Address - Country:US
Mailing Address - Phone:904-645-6976
Mailing Address - Fax:904-645-6978
Practice Address - Street 1:9889 GATE PKWY N BLDG 200
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9228
Practice Address - Country:US
Practice Address - Phone:904-645-6976
Practice Address - Fax:904-645-6978
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-120154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013211900Medicaid
FL013211900Medicaid