Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 25994 | WA |
NPI | 1003807058 |
---|---|
Provider Name | Dr. Robert C. Pedersen |
First Address | Honolulu, HI 96819-4430 |
Second Address | Honolulu, HI 96819-4430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |