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General NPI Number Information
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NPI Number | 1821651282
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Entity Type | Individual
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Provider Name | JACOB ANTHONY BEZOLD MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2019
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1200 PEABODY AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-4506
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Country | US
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Telephone | 901-707-6861
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Fax | 901-805-6300
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Provider Business Mailing Address
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Address Line | 1200 PEABODY AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-4506
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Country | US
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Telephone |
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Fax | 901-805-6300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 67663
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 67663
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 67663
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License Number State | TN
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