Healthcare Provider Details

I. General information

NPI: 1407837362
Provider Name (Legal Business Name): JOHN CARLYLE SCHLABACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLYLE SCHLABACH MD

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/10/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL ROAD
GANADO AZ
86515
US

IV. Provider business mailing address

1507 W MAIN ST
GATESVILLE TX
76528-1024
US

V. Phone/Fax

Practice location:
  • Phone: 928-755-4632
  • Fax: 928-755-4831
Mailing address:
  • Phone: 254-865-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM5489
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24456
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01037080A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20060005
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01037080A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24456
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: