Provider Demographics
NPI:1083791313
Name:PEDERSON, CHRISTOPHER A (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:PEDERSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROYALTON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0824
Mailing Address - Country:US
Mailing Address - Phone:702-289-4562
Mailing Address - Fax:877-721-6912
Practice Address - Street 1:401 ROYALTON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0824
Practice Address - Country:US
Practice Address - Phone:702-289-4562
Practice Address - Fax:877-721-6912
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV75462083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510737Medicaid
NV11656110OtherCAQH
NVCC6493OtherBLUE CROSS
NV102910Medicare UPIN
NVI65290Medicare UPIN