Provider Demographics
NPI:1235213513
Name:PEDERSEN, TERENCE SCOTT (DPM, FACFAS)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:SCOTT
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-655-1200
Mailing Address - Fax:605-655-1210
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:STE 2
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3700
Practice Address - Country:US
Practice Address - Phone:605-655-1200
Practice Address - Fax:605-655-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD172213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD480033885OtherRAILROAD MEDICARE
SD6800553Medicaid
NE10025775000Medicaid
NENA1399002Medicare PIN
SD0747440003Medicare NSC
SD6800553Medicaid
NE10025775000Medicaid