Provider Demographics
NPI:1518044759
Name:SCHKLAR, PAUL SAMUEL (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:SAMUEL
Last Name:SCHKLAR
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 1:2140 KINGSLEY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-272-7500
Mailing Address - Fax:904-272-7502
Practice Address - Street 1:2140 KINGSLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-272-7500
Practice Address - Fax:904-272-7502
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
E2055TMedicare PIN
FLE2055YMedicare ID - Type Unspecified
FLS72789Medicare UPIN