Organization
WALTER J M PEDERSEN JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER J M PEDERSEN JR. MD (PRESIDENT)
(340) 778-6110
Entity
Organization
Contact information
Practice address
SUNNY ISLE PROF BLDG, SUITE 3F, ST CROIX, VI 00823-4423
(340) 778-6110
(340) 778-2919
Mailing address
PO BOX 7840, CHRISTIANSTED, VI 00823-7840
(340) 778-6110
(340) 778-2919
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
653
VI
335E00000X
Prosthetic/Orthotic Supplier
Primary
653
VI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500138
HUMANA
VI
01
—
089045
BCBSVI
VI
01
—
1184808065
NPI
VI
01
—
170823200
USDL
VI
01
—
1780671909
NPI
VI
01
—
53699PE
TRIPLE-S
VI
01
—
VI000011
TRICARE
VI
Enumeration date
12/27/2007
Last updated
07/10/2012
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