Individual
JACOB HOSTETLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4602 US HIGHWAY 59, GROVE, OK 74344-4229
(918) 877-1211
(918) 877-1216
Mailing address
PO BOX 450130, GROVE, OK 74345-0130
(918) 877-1211
(918) 877-1216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31475
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200659910B
—
OK
Enumeration date
04/26/2015
Last updated
11/13/2022
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