Healthcare Provider Details

I. General information

NPI: 1811130669
Provider Name (Legal Business Name): DANIEL OLIVER PEDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE NEFF RD
BEND OR
97701-6337
US

IV. Provider business mailing address

1801 COLORADO AVE STE 120
TURLOCK CA
95382-2711
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4800
  • Fax: 541-706-4806
Mailing address:
  • Phone: 209-216-3456
  • Fax: 209-216-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: