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Individual

CHARLES LEE MARCUM

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8426
(606) 528-1212
Mailing address
284 ROSE HILL AVE, VERSAILLES, KY 40383-1224

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
28918
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000053343
BLUE CROSS BLUE SHIELD
KY
05
64289184
KY
Enumeration date
05/25/2006
Last updated
07/08/2007
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