Provider Demographics
NPI:1043236961
Name:CARALE, JESUS E (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:E
Last Name:CARALE
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 1:1112 CARSON AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2728
Mailing Address - Country:US
Mailing Address - Phone:719-383-6480
Mailing Address - Fax:719-383-6412
Practice Address - Street 1:1112 CARSON AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2728
Practice Address - Country:US
Practice Address - Phone:719-383-6480
Practice Address - Fax:719-383-6412
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39740207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07370342Medicaid
COCAA54671OtherBLUE CROSS
COP00175695OtherRAILROAD MEDICARE
CO07370342Medicaid
COC549838Medicare PIN