Provider Demographics
NPI:1720378169
Name:GUERRERO, CESAR ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:ENRIQUE
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-2620
Mailing Address - Country:US
Mailing Address - Phone:662-307-9030
Mailing Address - Fax:
Practice Address - Street 1:80 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-2620
Practice Address - Country:US
Practice Address - Phone:662-307-9030
Practice Address - Fax:662-307-9038
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN56136207N00000X, 207ND0900X
MS29717207ND0101X, 207ND0900X, 207NS0135X, 207N00000X
NY261924207ND0900X
FLME116247207ND0900X
ALMD.32613207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN56136OtherTENNESSEE
MS29717OtherMISSISSIPPI STATE MEDICAL LICENSE