Healthcare Provider Details

I. General information

NPI: 1306425814
Provider Name (Legal Business Name): JONATHAN BACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ROY CAMPBELL DR
HAZARD KY
41701-9407
US

IV. Provider business mailing address

181 ROY CAMPBELL DR
HAZARD KY
41701-9407
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-6779
  • Fax:
Mailing address:
  • Phone: 859-323-2834
  • Fax: 606-439-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59232
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: