MEDICARE: DR. ADAM PHILLIP PENDLETON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	10824745-1205	UT

General Provider Information

NPI Number	:	1013350982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM PHILLIP PENDLETON M.D.

Provider Business Mailing Address
First Line	:	3300 N TRIUMPH BLVD STE 500
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84043-6475
Country	:	US
Telephone Number	:	801-821-2781
Fax Number	:	801-901-1194

Provider Business Practice Location Address
First Line	:	6550 S MILLROCK DR STE 125
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-5794
Country	:	US
Telephone Number	:	801-821-2333
Fax Number	:	801-901-1194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	11/04/2020

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