Healthcare Provider Details

I. General information

NPI: 1386717668
Provider Name (Legal Business Name): JULES JACKSON BAREFOOT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BROADWAY
LOUISVILLE KY
40202
US

IV. Provider business mailing address

11804 RIDGE RD
ANCHORAGE KY
40223
US

V. Phone/Fax

Practice location:
  • Phone: 502-386-0656
  • Fax: 502-244-5783
Mailing address:
  • Phone: 502-386-0656
  • Fax: 502-244-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number24666
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: