Provider Demographics
NPI:1316988926
Name:PEDERSON, BRUCE M (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:PEDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:8097 HARBORVIEW RD
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-9639
Practice Address - Country:US
Practice Address - Phone:360-371-5855
Practice Address - Fax:360-371-5857
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00014727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080147969OtherRAILROAD MEDICARE
WA423898002OtherGROUP HEALTH COOPERATIVE
WA8924735OtherLABOR & INDUSTRIES (CV)
WA1722602Medicaid
WA14509OtherREGENCE BLUESHIELD
WA0128920OtherLABOR & INDUSTRIES (REG)
WAGAB08979Medicare PIN
WA8924735OtherLABOR & INDUSTRIES (CV)