Provider Demographics
NPI:1316208895
Name:SCHWARTZ, PAUL CONNELL (PA-S, LAC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CONNELL
Last Name:SCHWARTZ
Suffix:
Gender:
Credentials:PA-S, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SW 16TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2628
Mailing Address - Country:US
Mailing Address - Phone:206-538-6300
Mailing Address - Fax:206-538-6301
Practice Address - Street 1:1628 S MILDRED ST STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1628
Practice Address - Country:US
Practice Address - Phone:206-538-6300
Practice Address - Fax:206-538-6301
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60236931171100000X
WAPA60961599363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2138067Medicaid