Individual
DR. THEODORE S PAISLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 FOOTHILL DR, SALT LAKE CITY, UT 84112-1106
(801) 581-8000
Mailing address
PO BOX 510004, SALT LAKE CITY, UT 84151-0004
(801) 587-6600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4803526-1205
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
4803526-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00418797
RAILROAD MEDICARE
UT
Enumeration date
08/19/2006
Last updated
11/10/2021
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