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Contact Information

JACOB FUQUA
4003 KRESGE WAY STE 500
LOUISVILLE, KY40207-5603
 Phone: 502-897-1166
 Fax: 502-928-2988
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Hematology & Oncology

207RH0003X 11 Physician/Internal Medicine
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for JACOB FUQUA · (Male)

NPI # 1518490499
Status Active
Credentials
Entity Individual
Enumeration date 04/06/2017
Last updated 06/06/2025 - About 12 months ago
Sole proprietor 1 No
Identifiers
  • KY License # 60622
  • WV License # 29128
  • KY Medicaid 7101057390
Hospital affiliation(s)
  • WEST VIRGINIA UNIVERSITY HOSPITALS - (Acute Care)
    MEDICAL CENTER DRIVE
    MORGANTOWN, WV 26506
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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