Provider Demographics
NPI:1871511295
Name:CARLS, JEFFREY JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAY
Last Name:CARLS
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 1:1720 MESQUITE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-855-1550
Mailing Address - Fax:928-855-7229
Practice Address - Street 1:1720 MESQUITE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-855-1550
Practice Address - Fax:928-855-7229
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224593Medicaid
AZ0856320OtherBCBS
AZ26666Medicare ID - Type Unspecified
AZ0856320OtherBCBS