Provider Demographics
NPI:1154524478
Name:BRENDA JEAN JOBSON DO PLLC
Entity type:Organization
Organization Name:BRENDA JEAN JOBSON DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-678-8883
Mailing Address - Street 1:298 BOGLE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2836
Mailing Address - Country:US
Mailing Address - Phone:606-678-8883
Mailing Address - Fax:606-677-0220
Practice Address - Street 1:298 BOGLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2836
Practice Address - Country:US
Practice Address - Phone:606-678-8883
Practice Address - Fax:606-677-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02704207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65935611Medicaid
KY6922Medicare PIN
KYH32909Medicare UPIN