Provider Demographics
NPI:1356355986
Name:SCHLAICH, PAUL VERNAL (PA-C)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:VERNAL
Last Name:SCHLAICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 1815
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3271
Mailing Address - Country:US
Mailing Address - Phone:801-387-6520
Mailing Address - Fax:801-387-6525
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 1815
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-6520
Practice Address - Fax:801-387-6525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT369118-1206363A00000X
UT369118-8906363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical