Individual
JACOB FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4003 KRESGE WAY STE 500, LOUISVILLE, KY 40207-5603
(502) 897-1166
(502) 928-2988
Mailing address
1901 CAMPUS PL, LOUISVILLE, KY 40299-2308
(502) 253-5924
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
29128
WV
207RH0003X
Hematology & Oncology Physician
Primary
60622
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101057390
—
KY
Enumeration date
04/06/2017
Last updated
06/06/2025
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