Individual
DR. JESSE JEFFREY MATTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
208 MEDICAL PARK BLVD, BRISTOL, TN 37620-7343
(423) 990-3012
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0102206958
VA
207P00000X
Emergency Medicine Physician
04681
KY
207P00000X
Emergency Medicine Physician
Primary
DO0000003617
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2017
Last updated
12/07/2021
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