Provider Demographics
NPI:1134199227
Name:BACHLER, LEVI ROBERT (PAC)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:ROBERT
Last Name:BACHLER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 AARON DR STE B
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8138
Mailing Address - Country:US
Mailing Address - Phone:435-884-3578
Mailing Address - Fax:435-884-3582
Practice Address - Street 1:360 S 1300 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3761
Practice Address - Country:US
Practice Address - Phone:385-440-1400
Practice Address - Fax:801-845-9965
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA828363AM0700X
UT4967076-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502625Medicaid
NV100502639Medicaid
NV38666Medicare ID - Type Unspecified
NV100502625Medicaid