Healthcare Provider Details

I. General information

NPI: 1083791313
Provider Name (Legal Business Name): CHRISTOPHER A PEDERSON M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROYALTON DR
LAS VEGAS NV
89144-0824
US

IV. Provider business mailing address

401 ROYALTON DR
LAS VEGAS NV
89144-0824
US

V. Phone/Fax

Practice location:
  • Phone: 702-289-4562
  • Fax: 877-721-6912
Mailing address:
  • Phone: 702-289-4562
  • Fax: 877-721-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number7546
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: