Provider Demographics
NPI:1366452757
Name:PEDERSEN, CURTIS C (DPM)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:C
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 500 E
Mailing Address - Street 2:#130
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2408
Mailing Address - Country:US
Mailing Address - Phone:435-716-2800
Mailing Address - Fax:
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:#130
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-716-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2653460501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063460Medicare PIN
UTU59767Medicare UPIN