Healthcare Provider Details

I. General information

NPI: 1851374300
Provider Name (Legal Business Name): CARLES RAYLOR SURLES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 S HAWTHORNE RD
WINSTON SALEM NC
27103-4014
US

IV. Provider business mailing address

1830 S HAWTHORNE RD
WINSTON SALEM NC
27103-4014
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-2427
  • Fax: 336-765-2869
Mailing address:
  • Phone: 336-448-2427
  • Fax: 336-765-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD37312
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number200000634
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: