Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | F1893 | TX |
Y | 208600000X | Surgeon | F1893 | TX |
N | 2082S0105X | Plastic Hand Surgeon | F1893 | TX |
NPI | 1053387902 |
---|---|
Provider Name | Dr. William C Pederson |
First Address | San Antonio, TX 78240-1669 |
Second Address | San Antonio, TX 78240-1669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133003703 | (05) | TX |
C85937 | (02) | TX |