MEDICARE: DAVID ANDREW PEDERSEN MD

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
1	208600000X	Surgery Physician	23255	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972569200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ANDREW PEDERSEN MD

Provider Business Mailing Address
First Line	:	1712 W ANKLAM RD
Second Line	:	STE 103
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
Second Line	:	STE 103
City	:	TUCSON
State	:	AZ
Zip	:	85745-2660
Country	:	US
Telephone Number	:	520-622-7384
Fax Number	:	520-622-4899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	11/18/2022

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