Healthcare Provider Details

I. General information

NPI: 1356355986
Provider Name (Legal Business Name): PAUL VERNAL SCHLAICH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD SUITE 1815
OGDEN UT
84403-3271
US

IV. Provider business mailing address

4403 HARRISON BLVD SUITE 1815
OGDEN UT
84403-3271
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-6520
  • Fax: 801-387-6525
Mailing address:
  • Phone: 801-387-6520
  • Fax: 801-387-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number369118-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number369118-8906
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: