Provider Demographics
NPI:1922769017
Name:HILL, JACOB DWAYNE
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DWAYNE
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:HALE CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:79041-1452
Mailing Address - Country:US
Mailing Address - Phone:806-292-8320
Mailing Address - Fax:
Practice Address - Street 1:505 AVENUE K
Practice Address - Street 2:
Practice Address - City:HALE CENTER
Practice Address - State:TX
Practice Address - Zip Code:79041-1452
Practice Address - Country:US
Practice Address - Phone:806-292-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41648716171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty