Provider Demographics
NPI:1588793533
Name:PINEGAR, CALEB OGDEN (DO, ATC)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:OGDEN
Last Name:PINEGAR
Suffix:
Gender:M
Credentials:DO, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 W HORIZON RIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4186
Mailing Address - Country:US
Mailing Address - Phone:702-990-2290
Mailing Address - Fax:702-990-2297
Practice Address - Street 1:2779 W HORIZON RIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4186
Practice Address - Country:US
Practice Address - Phone:702-990-2290
Practice Address - Fax:702-990-2297
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0207020092255A2300X
NVDO2241207X00000X, 207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV187179Medicaid