Individual
JACOB DANIEL PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
INDEPENDENT DUTY CO
Contact information
Practice address
249 GLASSON, CORPUS CHRISTI, TX 78406-1817
(361) 939-0291
Mailing address
1201 MINNESOTA AVE, DULUTH, MN 55802-2424
(218) 529-3131
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
06/30/2023
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