Provider Demographics
NPI:1679599682
Name:JARBOE, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:JARBOE
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 1:1225 S. BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504
Mailing Address - Country:US
Mailing Address - Phone:859-258-4568
Mailing Address - Fax:859-258-4698
Practice Address - Street 1:1225 S. BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-258-4568
Practice Address - Fax:859-258-4698
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14574207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCB 5773OtherRR GROUP#
KY37903705OtherMEDICAID GROUP LAB#
KY4000501OtherMEDICARE LAB GROUP#
KY290009505OtherRR MEDICARE PIN
KY64145741Medicaid
C62856Medicare UPIN
KY0016951Medicare ID - Type Unspecified
0169Medicare PIN