Provider Demographics
NPI:1821739483
Name:WELLS, JACOB JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOSEPH
Last Name:WELLS
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:ABELL ADMINISTRATION BUILDING
Mailing Address - Street 2:323 EAST CHESTNUT STREET
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-1273
Mailing Address - Fax:
Practice Address - Street 1:ABELL ADMINISTRATION BUILDING
Practice Address - Street 2:323 EAST CHESTNUT STREET
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program