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General NPI Number Information
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NPI Number | 1932420874
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Entity Type | Individual
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Provider Name | MATTHEW BENNION PEADEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 304 S JONES BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone | 702-882-8675
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Fax |
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Provider Business Mailing Address
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Address Line | 11410 SEA SIDE DR
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City | FISHERS
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State | IN
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Zip | 46040-8201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | SL0737
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02004434
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License Number State | IN
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