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General NPI Number Information
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NPI Number | 1740367416
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Entity Type | Organization
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Legal Business Name | EUGENE E JACOB MD PLLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1023 NEW MOODY LN STE 102
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City | LAGRANGE
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State | KY
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Zip | 40031-9177
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Country | US
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Telephone | 502-222-0598
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Fax | 502-222-7446
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Provider Business Mailing Address
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Address Line | 1023 NEW MOODY LN STE 102
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City | LAGRANGE
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State | KY
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Zip | 40031-9177
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Country | US
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Telephone | 502-222-0598
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Fax | 502-222-7446
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUGENE E JACOB
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Credential | M.D.
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Telephone | 502-222-0598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 23227
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License Number State | KY
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