Provider Demographics
NPI:1972804201
Name:SCHMIDT, PAUL ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:SCHMIDT
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:PO BOX 7060
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7060
Mailing Address - Country:US
Mailing Address - Phone:480-444-2017
Mailing Address - Fax:480-718-1301
Practice Address - Street 1:3331 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2633
Practice Address - Country:US
Practice Address - Phone:480-444-2017
Practice Address - Fax:480-718-1301
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant