MEDICARE: JACOB BENJAMIN HENTGES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME154064	FL

General Provider Information

NPI Number	:	1740818830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB BENJAMIN HENTGES MD

Provider Business Mailing Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-398-7936
Fax Number	:	833-898-2600

Provider Business Practice Location Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-398-7936
Fax Number	:	833-898-2600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	07/22/2024

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