Individual
JOHN R PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, PMG PEDS HOSPITALISTS, ALBUQUERQUE, NM 87106-4930
(505) 841-1063
(505) 222-2695
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20030477
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90776224
—
NM
Enumeration date
10/03/2006
Last updated
07/16/2008
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