Provider Demographics
NPI:1780698779
Name:SCOBEE, JEREMY JAMES (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JAMES
Last Name:SCOBEE
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 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5132
Mailing Address - Country:US
Mailing Address - Phone:502-968-6979
Mailing Address - Fax:502-968-5444
Practice Address - Street 1:950 BRECKENRIDGE LN STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5929
Practice Address - Country:US
Practice Address - Phone:502-893-6777
Practice Address - Fax:502-899-5535
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64030844Medicaid
KY2623OtherBLUE CROSS
KY1141326OtherPASSPORT
KY2623OtherBLUE CROSS
KYK006090Medicare Oscar/Certification
KY1141326OtherPASSPORT