Individual
ROBERT W PEDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 E BUENA VISTA ST, SANTA FE, NM 87505-2621
(512) 970-3666
Mailing address
207 E BUENA VISTA ST, SANTA FE, NM 87505-2621
(512) 970-3666
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
E1920
TX
207RI0011X
Interventional Cardiology Physician
Primary
E1920
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1341851-03
—
TX
01
—
B25426
UPIN
—
Enumeration date
07/29/2005
Last updated
12/18/2015
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