Provider Demographics
NPI:1821651282
Name:BEZOLD, JACOB ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ANTHONY
Last Name:BEZOLD
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 1:18663 RUNNING DEER LN
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7589
Mailing Address - Country:US
Mailing Address - Phone:513-205-2372
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE STE 500
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4808
Practice Address - Country:US
Practice Address - Phone:901-746-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program