Provider Demographics
NPI:1295881811
Name:PEPPER, MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:PEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 S 1550 E STE 202
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5608
Mailing Address - Country:US
Mailing Address - Phone:385-432-3240
Mailing Address - Fax:716-333-8513
Practice Address - Street 1:6112 S 1550 E STE 202
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5608
Practice Address - Country:US
Practice Address - Phone:385-432-3240
Practice Address - Fax:716-333-8513
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7245724-1205208100000X, 2081S0010X
CO474942081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation