Individual
DR. WALTER JM PEDERSEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
SUNNY ISLE PROFESSIONAL BUILDING, SUITE 3-F, ST. CROIX, VI 00820-4423
(340) 778-6110
(340) 778-2919
Mailing address
PO BOX 7840, SUNNY ISLE PROFESSIONAL BLDG, STE 3, ST CROIX, VI 00823-7840
(340) 778-6110
(340) 778-2919
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
653
VI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500138
HUMANA
VI
01
—
089045
BLUE CROSS BLUE SHIELD VI
VI
01
—
1780671909
NPI
VI
01
—
53699PE
TRIPLE S
VI
01
—
V1000011
TRICARE
VI
Enumeration date
10/03/2005
Last updated
12/11/2007
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