Basic Information
| Provider Information | |||||||||
| NPI: | 1700080538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLIN | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | JAVIER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 PLEASANT ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152416542 | ||||||||
| FaxNumber: | 5152418789 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 PLEASANT ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152416542 | ||||||||
| FaxNumber: | 5152418789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 12/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | MD-38930 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1700080538 | 05 | IA | MEDICAID | 100265165-00 | 05 | NE | MEDICAID |