Healthcare Provider Details

I. General information

NPI: 1013350982
Provider Name (Legal Business Name): ADAM PHILLIP PENDLETON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 11/04/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 S MILLROCK DR STE 125
HOLLADAY UT
84121-5794
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

V. Phone/Fax

Practice location:
  • Phone: 801-821-2333
  • Fax: 801-901-1194
Mailing address:
  • Phone: 801-821-2781
  • Fax: 801-901-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10824745-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: