Provider Demographics
NPI:1326031246
Name:SCHLICHTER, GARY WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WARREN
Last Name:SCHLICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10026 GRANITE CREST LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-7219
Mailing Address - Country:US
Mailing Address - Phone:801-262-2673
Mailing Address - Fax:801-269-9894
Practice Address - Street 1:164 E 5900 S
Practice Address - Street 2:STE. A112
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7256
Practice Address - Country:US
Practice Address - Phone:801-262-2673
Practice Address - Fax:801-269-9894
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT30991141205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5552358546012Medicaid
UT5552358546012Medicaid