| Doctor Name: | RYAN D PEDERSON |
| NPI Number: | 1063605384 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | DP151127 |
| Business Practice Address: | 2699 N 17th St Coos Bay, OR - 974202134 |
| Business Phone Number: | 5412663600 |
| Business Fax Number: | |
| Mailing Address: | 2699 N 17th St, COOS BAY |
| State: | OR |
| Postal Code: | 974202134 |
| Phone Number: | 5412663600 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2007 |
| NPI Last Update Date: | 09/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | DP151127 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |