Provider Demographics
NPI:1063730109
Name:HODSKINS, JACOB S (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:S
Last Name:HODSKINS
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 1:1000 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0839
Mailing Address - Country:US
Mailing Address - Phone:270-688-3445
Mailing Address - Fax:270-688-3344
Practice Address - Street 1:1000 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0839
Practice Address - Country:US
Practice Address - Phone:270-688-3445
Practice Address - Fax:270-688-3344
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46047207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100265610Medicaid
IN201323490Medicaid
IN201323490Medicaid