Healthcare Provider Details

I. General information

NPI: 1437122454
Provider Name (Legal Business Name): JEFFREY B HARGIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 DUTCHMANS LN SUITE 405
LOUISVILLE KY
40207-4700
US

IV. Provider business mailing address

315 E BROADWAY
LOUISVILLE KY
40202-3700
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-3366
  • Fax: 502-899-3455
Mailing address:
  • Phone: 502-629-2500
  • Fax: 502-629-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35-05-2939-H
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01044991
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number32014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: