Provider Demographics
NPI:1386668689
Name:CARLEY, GEORGE J JR (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:CARLEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1943 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1519
Mailing Address - Country:US
Mailing Address - Phone:810-985-5700
Mailing Address - Fax:810-985-5454
Practice Address - Street 1:1943 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1519
Practice Address - Country:US
Practice Address - Phone:810-985-5700
Practice Address - Fax:810-985-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4463388Medicaid
0000159686704OtherUNITED HEALTHCARE
MI107951OtherCARE CHOICES HMO
MI33411OtherHEALTH PLAN OF MICHIGAN
MI5787190002OtherCIGNA HEALTHCARE
MI5677068OtherAETNA PPO
107951OtherPREFERRED CHOICES
P00028140OtherMEDICARE TRAVELERS/RR
MI0157400345OtherBLUE CROSS/BLU SHIELD
MI4463388Medicaid
P00028140OtherMEDICARE TRAVELERS/RR