Provider Demographics
NPI:1548363617
Name:PERGLER, HAROLD R (MCD, FAAA, CCC-A)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:R
Last Name:PERGLER
Suffix:
Gender:M
Credentials:MCD, FAAA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-295-9644
Mailing Address - Fax:801-299-1498
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-295-9644
Practice Address - Fax:801-299-1498
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT107744-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52868202012Medicaid
UT52868202012Medicaid