Jim P Pederson, PA
Physician Assistant, Medical in Rawlins, WY. Individual provider (NPI-1).
NPI number1902829773
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1902829773
- Entity type
- Individual (NPI-1)
- Name
- Jim P Pederson
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 25, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 083 | WY | Yes |
Practice location
606 23rd StRawlins, WY 82301-5127
Phone 307-324-6002
Mailing address
606 23rd StRawlins, WY 82301-5127
Phone 307-324-6002
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