Provider Demographics
NPI:1902986078
Name:AFFLECK, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:AFFLECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1380 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5217195-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1502954OtherUMWA
AZ442187002Medicaid
UT77511OtherPEHP
UT107022203101OtherIHC
UT52171951203001OtherBCBS
ID806809000Medicaid
UTQM0000075886OtherALTIUS
UT99456OtherHEALTHY U
UT2090168OtherUNITED HEALTHCARE
UT870545614PJAOtherEDUCATORS MUTUAL
UTTPRA08597OtherMOLINA
NV100502671Medicaid
WY119309100Medicaid
UT828828OtherDESERET MUTUAL
UTG84692Medicare UPIN
UTP00094648Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WY119309100Medicaid