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Individual

JEFFREY R PEDERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
14402 E SPRAGUE AVE, SPOKANE VALLEY, WA 99216-2167
(509) 922-2625
(509) 922-4001
Mailing address
14402 E SPRAGUE AVE, SPOKANE VALLEY, WA 99216-2167
(509) 922-2625
(509) 922-4001

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
O221
ID
207Q00000X
Family Medicine Physician
Primary
OP00001642
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010005518
REGENCE BLUESHIELD
ID
05
1043078
WA
01
129223
WA LABOR & INDUSTRIES
WA
01
1301819
DMERC
ID
01
805453200
HEALTHY CONNECTIONS
ID
05
805453200
ID
01
S3143
BLUE CROSS
ID
Enumeration date
10/23/2006
Last updated
04/28/2021
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