Healthcare Provider Details

I. General information

NPI: 1134227911
Provider Name (Legal Business Name): JENNIFER LYNN HOBBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 FALLS DR
FORT WAYNE IN
46804-7147
US

IV. Provider business mailing address

5750 FALLS DR
FORT WAYNE IN
46804-7147
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-8000
  • Fax: 260-432-5587
Mailing address:
  • Phone: 260-436-8000
  • Fax: 260-432-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01048931A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number01048931A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: