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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

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