Healthcare Provider Details

I. General information

NPI: 1386480523
Provider Name (Legal Business Name): ANTON PELED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY STE 201
POCATELLO ID
83201-5175
US

IV. Provider business mailing address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-2620
  • Fax:
Mailing address:
  • Phone: 208-239-1035
  • Fax: 208-239-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2281427
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: