Provider Demographics
NPI:1811130669
Name:PEDERSON, DANIEL OLIVER (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:OLIVER
Last Name:PEDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1801 COLORADO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2711
Mailing Address - Country:US
Mailing Address - Phone:209-216-3456
Mailing Address - Fax:209-216-3462
Practice Address - Street 1:2600 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6337
Practice Address - Country:US
Practice Address - Phone:541-706-4800
Practice Address - Fax:541-706-4806
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2024-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A17049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316963721OtherPRIVATE