Basic Information
Provider Information
NPI: 1598874224
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOBBS
FirstName: JENNY
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3366
Address2:  
City: PORTLAND
State: OR
PostalCode: 972083360
CountryCode: US
TelephoneNumber: 8667472455
FaxNumber:  
Practice Location
Address1: 1321 COLBY AVE
Address2:  
City: EVERETT
State: WA
PostalCode: 982011665
CountryCode: US
TelephoneNumber: 4252612000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2006
LastUpdateDate: 03/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XMD60022459WAN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XMD60022459WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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