Individual
DR. CHARLES D JARBOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
912 WALLACE AVE, SUITE 103, LEITCHFIELD, KY 42754-2404
(270) 230-8200
(270) 230-0882
Mailing address
912 WALLACE AVE STE 103, LEITCHFIELD, KY 42754-2405
(270) 230-8200
(270) 230-0882
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22717
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000222830
ANTHEM PIN #
KY
01
—
10804168
CAQH UNIVERSAL CREDENTIAL
—
01
—
18D0999959
CLIA
—
01
—
320012117
TAX ID
KY
05
—
64227176
—
KY
Enumeration date
07/06/2005
Last updated
07/09/2007
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