Healthcare Provider Details

I. General information

NPI: 1235213513
Provider Name (Legal Business Name): TERENCE SCOTT PEDERSEN DPM, FACFAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 4TH ST STE 2
YANKTON SD
57078-3700
US

IV. Provider business mailing address

1000 W 4TH ST STE 2
YANKTON SD
57078-3700
US

V. Phone/Fax

Practice location:
  • Phone: 605-655-1200
  • Fax: 605-655-1210
Mailing address:
  • Phone: 605-655-1200
  • Fax: 605-655-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number172
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: