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General NPI Number Information
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NPI Number | 1629151428
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Entity Type | Individual
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Provider Name | JEFFREY R PEDERSEN DO
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 14402 E SPRAGUE AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-2167
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Country | US
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Telephone | 509-922-2625
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Fax | 509-922-4001
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Provider Business Mailing Address
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Address Line | 14402 E SPRAGUE AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-2167
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Country | US
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Telephone | 509-922-2625
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Fax | 509-922-4001
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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 | O221
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License Number State | ID
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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 | OP00001642
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License Number State | WA
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