Provider Demographics
NPI:1386480523
Name:PELED, ANTON (MD)
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:PELED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 NORTH MEDICAL DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2303
Mailing Address - Country:US
Mailing Address - Phone:801-581-5584
Mailing Address - Fax:801-581-4385
Practice Address - Street 1:175 NORTH MEDICAL DRIVE EAST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2303
Practice Address - Country:US
Practice Address - Phone:801-581-5584
Practice Address - Fax:801-581-4385
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program