Provider Demographics
NPI:1538344809
Name:HORD, JACOB (DPM)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 KINGWOOD MEDICAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6405
Mailing Address - Country:US
Mailing Address - Phone:281-348-2166
Mailing Address - Fax:281-358-2153
Practice Address - Street 1:350 KINGWOOD MEDICAL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6405
Practice Address - Country:US
Practice Address - Phone:281-348-2166
Practice Address - Fax:281-358-2153
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2136213E00000X
KY00334213ES0103X
KY000334213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639368970OtherGROUP NPI
TX1639368970OtherGROUP NPI