Provider Demographics
NPI:1790709483
Name:JACOB, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:JACOB
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-361-1222
Mailing Address - Fax:502-368-1258
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1144
Practice Address - Country:US
Practice Address - Phone:502-361-1222
Practice Address - Fax:502-368-1258
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-11-24
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Provider Licenses
StateLicense IDTaxonomies
KY17749207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64177496Medicaid
KYC63038Medicare UPIN
KY00546107Medicare Oscar/Certification
KYP00396054Medicare PIN