Healthcare Provider Details

I. General information

NPI: 1003034828
Provider Name (Legal Business Name): TYLER CHRISTIAN PEDERSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981150 NEBRASKA MEDICAL CTR
OMAHA NE
68198-1150
US

IV. Provider business mailing address

5625 S 33RD AVE
OMAHA NE
68107-3328
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6802
  • Fax:
Mailing address:
  • Phone: 402-731-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberNE5284
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: