Individual
DONALD M PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1138 WILMINGTON AVE, SALT LAKE CITY, UT 84106-2819
(801) 581-2000
Mailing address
PO BOX 510004, SALT LAKE CITY, UT 84151-0004
(801) 587-6600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
104325-1206
UT
Other
Enumeration date
10/13/2006
Last updated
07/08/2007
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