Healthcare Provider Details

I. General information

NPI: 1225084593
Provider Name (Legal Business Name): ROBERT SCOTT JOLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S LOOP RD
EDGEWOOD KY
41017-3405
US

IV. Provider business mailing address

11140 MONTGOMERY RD
CINCINNATI OH
45249-2309
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2663
  • Fax:
Mailing address:
  • Phone: 513-221-5500
  • Fax: 513-221-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35060711
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: