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General NPI Number Information
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NPI Number | 1881857019
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Entity Type | Individual
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Provider Name | CHAD A PEDERSEN MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 709 4TH AVE NE
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City | WATFORD CITY
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State | ND
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Zip | 58854-7628
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Country | US
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Telephone | 701-842-3000
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Fax | 701-842-4025
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Provider Business Mailing Address
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Address Line | 1836 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5429
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Country | US
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Telephone | 608-782-7300
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 55437
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 60620
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 60620
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 60620
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License Number State | MT
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 21785
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License Number State | ND
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