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General NPI Number Information
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NPI Number | 1316988926
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Entity Type | Individual
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Provider Name | BRUCE M PEDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 8097 HARBORVIEW RD
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City | BLAINE
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State | WA
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Zip | 98230-9639
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Country | US
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Telephone | 360-371-5855
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Fax | 360-371-5857
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Provider Business Mailing Address
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Address Line | 709 W ORCHARD DR SUITE 4
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City | BELLINGHAM
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State | WA
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Zip | 98225-1766
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Country | US
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Telephone | 360-318-8800
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Fax | 360-318-1085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00014727
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License Number State | WA
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