Individual
JACOB R HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-0990
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-0990
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
104519
MN
2085R0202X
Diagnostic Radiology Physician
52240
MN
2085R0202X
Diagnostic Radiology Physician
Primary
MD218008
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
05
—
ENROLLED
—
WI
01
—
P01235327
RAILROAD MEDICARE
MN
Enumeration date
06/18/2008
Last updated
01/18/2024
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