Provider Demographics
NPI:1992791685
Name:SELBY, JEFFREY W (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:SELBY
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47629-0249
Mailing Address - Country:US
Mailing Address - Phone:812-853-5864
Mailing Address - Fax:812-853-5610
Practice Address - Street 1:10288 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7952
Practice Address - Country:US
Practice Address - Phone:812-853-5864
Practice Address - Fax:812-853-5610
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35712207RC0200X, 207RP1001X
IN01027862A207RC0200X, 207RP1001X
IN71002793B363LA2100X
KY3005907363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000307442OtherANTHEM
IN000000307442OtherANTHEM
IN100138760CMedicaid
KY64754484Medicaid
INBS2641884OtherDEA
KY64754484Medicaid
D94991Medicare UPIN
KY1865701Medicare ID - Type Unspecified
KY64754484Medicaid