MEDICARE: DR. PAUL M STRATTON PHD, MBA

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	103T00000X	Psychologist	6089085-2504	UT

General Provider Information

NPI Number	:	1730122318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL M STRATTON PHD, MBA

Provider Business Mailing Address
First Line	:	525 E 100 S STE 120
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2070
Country	:	US
Telephone Number	:	801-450-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 100 S STE 120
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2070
Country	:	US
Telephone Number	:	801-450-1128
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	04/06/2009

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