Healthcare Provider Details

I. General information

NPI: 1619327780
Provider Name (Legal Business Name): DANIEL ALAN PEDERSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8246 RIVER COUNTRY DR
WEEKI WACHEE FL
34607-2101
US

IV. Provider business mailing address

8246 RIVER COUNTRY DR # 93
WEEKI WACHEE FL
34607-2101
US

V. Phone/Fax

Practice location:
  • Phone: 352-684-8637
  • Fax:
Mailing address:
  • Phone: 352-684-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS16743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: