Provider Demographics
NPI:1619327780
Name:PEDERSEN, DANIEL ALAN (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8246 RIVER COUNTRY DR # 93
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2101
Mailing Address - Country:US
Mailing Address - Phone:352-684-8637
Mailing Address - Fax:
Practice Address - Street 1:8246 RIVER COUNTRY DR
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-2101
Practice Address - Country:US
Practice Address - Phone:352-684-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16743207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine