Provider Demographics
NPI:1750312369
Name:DIVINO, CAESAR S (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAESAR
Middle Name:S
Last Name:DIVINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 TURTLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2351
Mailing Address - Country:US
Mailing Address - Phone:501-221-9857
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR BLDG 661
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3474
Practice Address - Fax:501-257-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR164213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145589748Medicaid
AR5G857Medicare PIN
ARU66263Medicare UPIN
5023800001Medicare NSC
5T571Medicare PIN