Provider Demographics
NPI:1851374300
Name:SURLES, CARLES RAYLOR JR (MD)
Entity type:Individual
Prefix:DR
First Name:CARLES
Middle Name:RAYLOR
Last Name:SURLES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1830 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4014
Mailing Address - Country:US
Mailing Address - Phone:336-448-2427
Mailing Address - Fax:336-765-2869
Practice Address - Street 1:1830 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4014
Practice Address - Country:US
Practice Address - Phone:336-448-2427
Practice Address - Fax:336-765-2869
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37312207RG0100X
NC200000634207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04067Medicare UPIN
TN3884202Medicare ID - Type Unspecified