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General NPI Number Information
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NPI Number | 1568991446
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Entity Type | Individual
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Provider Name | CALLIE PEDERSON D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 7901 4TH ST N STE 14102
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 813-280-0124
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Fax | 904-341-5249
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 14102
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 813-280-0124
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Fax | 904-341-5249
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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 | 0102205476
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TPOS764
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024-03407
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License Number State | NC
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