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NPI Code Detail

MEDICARE: MATTHEW PAUL

MEDICARE: MATTHEW PAUL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant8452730-1206UT

General Provider Information

NPI Number : 1912407180
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW PAUL
Provider Business Mailing Address
First Line : PO BOX 3024
Second Line :
City : JACKSON
State : WY
Zip : 83001-3024
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1784 UINTA WAY UNIT E2
Second Line :
City : PARK CITY
State : UT
Zip : 84098-7685
Country : US
Telephone Number : 435-604-0160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 02/14/2018

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Directions to “ MATTHEW PAUL ” Practice Location

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