Healthcare Provider Details

I. General information

NPI: 1942733977
Provider Name (Legal Business Name): JACOB ELROD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 06/13/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 KENTUCKY AVENUE, MED PARK 1 SUITE 301
PADUCAH KY
42003
US

IV. Provider business mailing address

2811 VILLAGE LN
BIRMINGHAM AL
35211-5807
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-3113
  • Fax: 270-575-3135
Mailing address:
  • Phone: 205-902-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.37493
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.37493
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberTP710
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: