Provider Demographics
NPI:1700306859
Name:HANIN, JACOB BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:BERNARD
Last Name:HANIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9811
Mailing Address - Country:US
Mailing Address - Phone:270-417-4700
Mailing Address - Fax:270-417-4709
Practice Address - Street 1:1201 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9811
Practice Address - Country:US
Practice Address - Phone:270-417-4700
Practice Address - Fax:270-417-4709
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY54016207R00000X
MO2019035095207R00000X
MO2017020351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine