Provider Demographics
NPI:1356369094
Name:PEDERSON, JANET L (MD)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:L
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14991 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3983
Mailing Address - Country:US
Mailing Address - Phone:303-690-4891
Mailing Address - Fax:303-690-5082
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3983
Practice Address - Country:US
Practice Address - Phone:303-690-4891
Practice Address - Fax:303-690-5082
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269307Medicaid
94238Medicare ID - Type Unspecified
CO01269307Medicaid