Provider Demographics
NPI:1760093595
Name:JCMD, PC
Entity Type:Organization
Organization Name:JCMD, PC
Other - Org Name:DR JEFF CARLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-855-1550
Mailing Address - Street 1:1720 MESQUITE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5644
Mailing Address - Country:US
Mailing Address - Phone:928-855-1550
Mailing Address - Fax:928-855-4008
Practice Address - Street 1:1720 MESQUITE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5644
Practice Address - Country:US
Practice Address - Phone:928-855-1550
Practice Address - Fax:928-855-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty