MEDICARE: BRANDON TAYLOR JACOBS BOYD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	05870	KY

General Provider Information

NPI Number	:	1376117762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON TAYLOR JACOBS BOYD DO

Provider Business Mailing Address
First Line	:	5200 COMMERCE CROSSINGS DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-2182
Country	:	US
Telephone Number	:	502-245-4168
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 BLUEGRASS PKWY STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2302
Country	:	US
Telephone Number	:	502-245-4168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	07/26/2024

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