Provider Demographics
NPI:1437253515
Name:PESSONEY, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:PESSONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5912 OLD MOBILE HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4520
Mailing Address - Country:US
Mailing Address - Phone:228-471-1000
Mailing Address - Fax:228-471-1039
Practice Address - Street 1:5912 OLD MOBILE HIGHWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581
Practice Address - Country:US
Practice Address - Phone:228-471-1000
Practice Address - Fax:228-471-1039
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030006292083X0100X
MS208632083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204642102OtherMEDICAID
MO243419306Medicaid
MO243419306Medicaid