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Charles Matthew Pesson
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NPI Number Detailed Information
Provider Information:
| Name: | Charles Matthew Pesson |
| Gender: | M |
| Provider License Number If Given: | 53502 |
NPI Information:
| NPI: | 1699778613 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 4/21/2020 |
Provider Business Mailing Address:
| Address: | 245 FLEMINGSBURG RD Morehead, KY 40351 |
| Phone Number: | 6067805500 |
| Fax Number: | 6067837281 |
Provider Business Practice Location Address:
| Address: | 245 FLEMINGSBURG RD Morehead, KY 40351 |
| Phone Number: | 6067805500 |
| Fax Number: | 6067837281 |
Provider Taxonomy:
| Primary: | 207X00000X |
| Secondary (if any): | 207XX0005X |
| State: | KY |
