Healthcare Provider Details

I. General information

NPI: 1295952364
Provider Name (Legal Business Name): WILLIAM PEDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THOMPSON DR
KERRVILLE TX
78028-5144
US

IV. Provider business mailing address

819 WATER ST SUITE 300
KERRVILLE TX
78028-5333
US

V. Phone/Fax

Practice location:
  • Phone: 830-257-6553
  • Fax: 830-896-4448
Mailing address:
  • Phone: 830-792-3300
  • Fax: 830-792-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberD3364
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD3364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: