Provider Demographics
NPI:1437472867
Name:SCHLEGEL, WILLIAM MAXFIELD (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAXFIELD
Last Name:SCHLEGEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E HIGHLAND AVE STE 251
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3800
Practice Address - Country:US
Practice Address - Phone:909-882-4605
Practice Address - Fax:909-475-2680
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20886OtherLICENSE
CADN695ZMedicare PIN
ZZZ07161ZOtherMEDICARE GROUP PTAN
CAPA20886OtherLICENSE
CADN695ZMedicare PIN