Provider Demographics
NPI:1144210113
Name:TOLBERT, JERRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-351-9900
Mailing Address - Fax:513-366-4491
Practice Address - Street 1:8780 US 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6936
Practice Address - Country:US
Practice Address - Phone:859-384-8338
Practice Address - Fax:859-384-8320
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33140207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64331408Medicaid
KYP00873396OtherRAIL ROAD MEDICARE
KY080141093OtherRAILROAD MEDICARE
KY64331408Medicaid
KY0398218Medicare PIN
KY008580060Medicare PIN
KYP00873396OtherRAIL ROAD MEDICARE
KY64331408Medicaid
KY0969416Medicare PIN
OH2273749Medicaid