Provider Demographics
NPI:1497921175
Name:SCALES, CHARLES DOUGLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:SCALES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 MEDICINE CIR
Mailing Address - Street 2:ROOM 1571
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-1999
Mailing Address - Fax:919-684-4611
Practice Address - Street 1:40 MEDICINE CIR
Practice Address - Street 2:ROOM 1571
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-1999
Practice Address - Fax:919-684-4611
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2013-09-06
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Provider Licenses
StateLicense IDTaxonomies
CAA115214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497921175Medicaid
CA1497921175Medicaid