Provider Demographics
NPI:1205457991
Name:LADE, CALEB ADRIAN
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:ADRIAN
Last Name:LADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 N 200 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1302
Mailing Address - Country:US
Mailing Address - Phone:918-808-8399
Mailing Address - Fax:
Practice Address - Street 1:577 N 200 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1302
Practice Address - Country:US
Practice Address - Phone:918-808-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program