Provider Demographics
NPI:1013350982
Name:PENDLETON, ADAM PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PHILLIP
Last Name:PENDLETON
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 1:3300 N TRIUMPH BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6475
Mailing Address - Country:US
Mailing Address - Phone:801-821-2781
Mailing Address - Fax:801-901-1194
Practice Address - Street 1:6550 S MILLROCK DR STE 125
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-5794
Practice Address - Country:US
Practice Address - Phone:801-821-2333
Practice Address - Fax:801-901-1194
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10824745-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry