Individual
DR. JASEN THOMAS PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6400 WESTWIND WAY, SUITE B, CRESTWOOD, KY 40014-6773
(502) 276-9999
(502) 276-9999
Mailing address
6400 WESTWIND WAY, SUITE B, CRESTWOOD, KY 40014-6773
(502) 276-9999
(502) 276-9999
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
243971
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
243971
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000866560
ANTHEM
KY
05
—
7100170810
—
KY
Enumeration date
07/28/2008
Last updated
04/27/2020
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