Healthcare Provider Details

I. General information

NPI: 1720003916
Provider Name (Legal Business Name): CHARLES KEITH SEHON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PECK BLVD.
LAFAYETTE LA
70508-7328
US

IV. Provider business mailing address

102 PECK BLVD
LAFAYETTE LA
70508-7328
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-6214
  • Fax: 337-984-6214
Mailing address:
  • Phone: 337-984-6214
  • Fax: 337-984-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.017085
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: