MEDICARE: MR. MATTHEW BENNION PEADEN D.O.

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	174400000X	Specialist	SL0737	NV
2	207L00000X	Anesthesiology Physician	02004434	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01424390	OTHER	IN	RAIL ROAD PTAN

General Provider Information

NPI Number	:	1932420874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW BENNION PEADEN D.O.

Provider Business Mailing Address
First Line	:	11410 SEA SIDE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46040-8201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	702-882-8675
Fax Number	:

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	10/14/2025

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