Provider Demographics
NPI:1578575254
Name:JACOBS, JAMIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD STE A300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3787
Mailing Address - Country:US
Mailing Address - Phone:859-276-4429
Mailing Address - Fax:859-276-5910
Practice Address - Street 1:1401 HARRODSBURG RD STE A300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3787
Practice Address - Country:US
Practice Address - Phone:859-276-4429
Practice Address - Fax:859-276-5910
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16157207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC64471Medicare UPIN