Provider Demographics
NPI:1821195579
Name:DIEHL, PAUL J (MD, PC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:DIEHL
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 FT UNION BLVD
Mailing Address - Street 2:107
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6800
Mailing Address - Country:US
Mailing Address - Phone:801-993-9527
Mailing Address - Fax:
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-993-9527
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT162707-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT195322Medicaid
UT870625972DI2OtherEDUCATORS MUTUAL
UT53217OtherPEHP
UT107009460102OtherIHC
UT2000164OtherUNITED HEALTHCARE
UTQM0000048401OtherALTIUS
UTD20168Medicare UPIN
UT005585203Medicare ID - Type Unspecified
UTQM0000048401OtherALTIUS