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Individual

LARS PEDERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7308 NW 114TH ST, OKLAHOMA CITY, OK 73162
(405) 473-5817
Mailing address
7308 NW 114TH ST, OKLAHOMA CITY, OK 73162-2703

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary

Other

Enumeration date
05/25/2018
Last updated
12/13/2018
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