Provider Demographics
NPI:1407837362
Name:SCHLABACH, JOHN CARLYLE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARLYLE
Last Name:SCHLABACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLYLE
Other - Middle Name:
Other - Last Name:SCHLABACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1507 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1024
Mailing Address - Country:US
Mailing Address - Phone:254-865-8251
Mailing Address - Fax:
Practice Address - Street 1:3137 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4069
Practice Address - Country:US
Practice Address - Phone:602-325-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5489207P00000X
AZ24456207P00000X, 207Q00000X
IN01037080A207P00000X, 207Q00000X
NMMD20060005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ360397Medicaid
NM75208300Medicaid
IN360397Medicaid
AZ360397Medicaid
IN360397Medicaid