Provider Demographics
NPI:1841702057
Name:TRIA, CEASAR R (PA-C)
Entity type:Individual
Prefix:
First Name:CEASAR
Middle Name:R
Last Name:TRIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5254
Mailing Address - Country:US
Mailing Address - Phone:910-937-0008
Mailing Address - Fax:910-937-0098
Practice Address - Street 1:2420 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-937-0008
Practice Address - Fax:910-937-0098
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-07662OtherNC MEDICAL LICENSE
NC0010-07662OtherNC MEDICAL LICENSE