Provider Demographics
NPI:1437122454
Name:HARGIS, JEFFREY B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:HARGIS
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 1:315 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3700
Mailing Address - Country:US
Mailing Address - Phone:502-629-2500
Mailing Address - Fax:502-629-2055
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE 405
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-3455
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-2939-H207RH0003X
IN01044991207RH0003X
KY32014207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64320146Medicaid
1068542OtherPASSPORT
830005454OtherRAILROAD MEDICARE
000000051748OtherANTHEM
IN200101660AMedicaid
KY64320146Medicaid
IN145250BMedicare ID - Type Unspecified
IN200101660AMedicaid