Individual
GARY DUANE PEDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 DEER TRL NW, CLEVELAND, TN 37312-1110
(423) 331-0501
Mailing address
111 DEER TRL NW, CLEVELAND, TN 37312-1110
(423) 331-0501
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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