MEDICARE: MR. SPENCER W SCHMUTZ PA-C

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1477156214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SPENCER W SCHMUTZ PA-C

Provider Business Mailing Address
First Line	:	1449 N 1400 W STE 19
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5237
Country	:	US
Telephone Number	:	435-688-7572
Fax Number	:	435-275-4939

Provider Business Practice Location Address
First Line	:	1449 N 1400 W STE 19
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5237
Country	:	US
Telephone Number	:	435-688-7572
Fax Number	:	435-275-4939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	05/10/2022

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