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NPI Code Detail

MEDICARE: DAVID A PEDERSEN MD PC

MEDICARE: DAVID A PEDERSEN MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist23255AZ

General Provider Information

NPI Number : 1669672747
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID A PEDERSEN MD PC
Provider Business Mailing Address
First Line : 1712 W ANKLAM RD STE 103
Second Line :
City : TUCSON
State : AZ
Zip : 85745-2660
Country : US
Telephone Number : 520-622-7384
Fax Number : 520-622-4899
Provider Business Practice Location Address
First Line : 1712 W ANKLAM RD STE 103
Second Line :
City : TUCSON
State : AZ
Zip : 85745-2660
Country : US
Telephone Number : 520-622-7384
Fax Number : 520-622-4899
Authorized Official
Title or Position : OWNER
Name : DR. DAVID ANDREW PEDERSEN
Credential : MD
Telephone Number : 520-622-7384
Provider Enumeration Date : 07/18/2007
Last Update Date : 07/18/2007

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Directions to “DAVID A PEDERSEN MD PC ” Practice Location

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