Individual
GLENN A PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1850 CHADWICK DR, JACKSON, MS 39204-3404
(601) 376-2944
Mailing address
18167 US HIGHWAY 19 N, SUITE 285, CLEARWATER, FL 33764-3528
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ARNP1604312
FL
363L00000X
Nurse Practitioner
Primary
R878258
MS
Other
Enumeration date
12/19/2007
Last updated
07/09/2010
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