Provider Demographics
NPI:1265439145
Name:REX, JAMES CALDWELL JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CALDWELL
Last Name:REX
Suffix:JR
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:60 BEAR DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605
Practice Address - Country:US
Practice Address - Phone:864-269-5500
Practice Address - Fax:864-269-8568
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15418208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863136OtherBCBS OF SC
SC154184Medicaid
SC576007863153OtherBLUE CHOICE
SC154184Medicaid
SCE815623640Medicare PIN
SCE81562Medicare UPIN