Individual
JEFFREY ALLEN PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12493 UNIVERSITY AVE STE 100, CLIVE, IA 50325-8286
(515) 358-9461
(515) 358-9489
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 358-9461
(515) 358-9489
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
3976
IA
208100000X
Physical Medicine & Rehabilitation Physician
5101016420
MI
208100000X
Physical Medicine & Rehabilitation Physician
Primary
DO-03976
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164196
HEALTH ALLIANCE
IA
01
—
500301
COVENTRY HEALTH CARE
IA
Enumeration date
04/06/2007
Last updated
07/11/2024
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