Provider Demographics
NPI:1508809344
Name:CARLES, JAVIER ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:CARLES
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:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1612 CHAPIN RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9304
Practice Address - Country:US
Practice Address - Phone:803-345-3414
Practice Address - Fax:803-345-1672
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080174872OtherRR MEDICARE
SCT66871Medicaid
SC080174872OtherRR MEDICARE
SCH36364Medicare UPIN
SCH36364Medicare UPIN