Healthcare Provider Details

I. General information

NPI: 1548363617
Provider Name (Legal Business Name): HAROLD R. PERGLER MCD, FAAA, CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MEDICAL DR SUITE 200
BOUNTIFUL UT
84010-4945
US

IV. Provider business mailing address

425 MEDICAL DR SUITE 200
BOUNTIFUL UT
84010-4945
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-9644
  • Fax: 801-299-1498
Mailing address:
  • Phone: 801-295-9644
  • Fax: 801-299-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number107744-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: