| Doctor Name: | DR. WALTER JM PEDERSEN |
| NPI Number: | 1780671909 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 653 |
| Business Practice Address: | Sunny Isle Professional Building Suite 3-f St. Croix, VI - 008204423 |
| Business Phone Number: | 3407786110 |
| Business Fax Number: | 3407782919 |
| Mailing Address: | Po Box 7840, Sunny Isle Professional Bldg, Ste 3 ST CROIX |
| State: | VI |
| Postal Code: | 008237840 |
| Phone Number: | 3407786110 |
| Fax Number: | 3407782919 |
| NPI Enumeration Date: | 10/03/2005 |
| NPI Last Update Date: | 12/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 653 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |