Healthcare Provider Details

I. General information

NPI: 1053261800
Provider Name (Legal Business Name): WOLFGANG SCHULTHESS PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 W SILVER CHOLLA LN
ST GEORGE UT
84770-1475
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 760-669-7462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14286788-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: