Provider Demographics
NPI:1750977237
Name:MICHELLE PEPPER MD PC
Entity type:Organization
Organization Name:MICHELLE PEPPER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-432-3240
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:385-238-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty