Individual
MR. MICHAEL P EDERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1001 COLLEGE BLVD W STE H, NICEVILLE, FL 32578-1049
(850) 279-4417
(850) 279-4212
Mailing address
1001 COLLEGE BLVD STE H, NICEVILLE, FL 32578-1049
(850) 279-4417
(850) 279-4212
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
OS9533
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
PM 126, DO 136
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16148
BLUE CROSS BLUE SHIELD
FL
05
—
273858900
—
FL
01
—
511-23910
BLUE CROSS
AL
01
—
511-61498
BC
AL
01
—
P00271270
RAILROAD MEDICARE
FL
01
—
PO1328054
RAILROAD MEDICARE
AL
Enumeration date
09/16/2006
Last updated
07/27/2017
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