Individual
DR. EUGENE E JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1023 NEW MOODY LN, SUITE 102, LAGRANGE, KY 40031-9177
(502) 222-0598
(502) 222-7446
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
23227
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000621578
ANTHEM
KY
01
—
3723478000
PASSPORT ADVANTAGE
KY
01
—
50024594
PASSSPORT
KY
05
—
64232275
—
KY
Enumeration date
07/26/2006
Last updated
12/07/2020
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