Provider Demographics
NPI:1992704357
Name:JAEKLE, RONALD K (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:JAEKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 ALCOA HWY STE A435
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1520
Mailing Address - Country:US
Mailing Address - Phone:865-263-2400
Mailing Address - Fax:865-263-2441
Practice Address - Street 1:1930 ALCOA HWY STE A435
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1520
Practice Address - Country:US
Practice Address - Phone:865-263-2400
Practice Address - Fax:865-263-2441
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29190207VM0101X
TN28922207VM0101X
OH35-061570207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0850324Medicaid
KY64867203Medicaid
TN1522457Medicaid
OH0850324Medicaid
OHJA4215731Medicare PIN