Individual
DR. ITHAN D PELTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5121 S COTTONWOOD ST, MURRAY, UT 84107-5701
(801) 507-6556
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 507-6556
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
9538134-8905
UT
207RP1001X
Pulmonary Disease Physician
Primary
9538134-8905
UT
Other
Enumeration date
06/11/2009
Last updated
02/10/2016
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