Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO1128 | FL |
N | 222Z00000X | Podiatrist | PO1128 | FL |
N | 213ES0103X | Foot & Ankle Surgery | PO 1128 | FL |
Y | 213ES0131X | Foot Surgery | PO 1128 | FL |
NPI | 1003826306 |
---|---|
Provider Name | Dr. Larry Hodson |
First Address | Panama City, FL 32405-4531 |
Second Address | Panama City, FL 32405-4531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 10/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061666115 | TAX ID (01) | FL |
45803 | BLUECROSSBLUESHEIL GROUP (01) | FL |
480035195 | RR MEDICARE (01) | FL |
87594 | BLUECROSSBLUESHIELD OF FL (01) | FL |
CK8386 | RR MEDICARE GROUP # (01) | FL |
T86771 | (02) | FL |