Individual
PAUL JACK UTSLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 COMMODORE DR, BELLEVILLE, IL 62223-2101
(331) 214-2559
Mailing address
5 COMMODORE DR, BELLEVILLE, IL 62223-2101
(331) 214-2559
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3927
NEMT
—
Enumeration date
06/15/2022
Last updated
06/15/2022
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