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Individual

DR. LARRY HODSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
2201 JENKS AVE, PANAMA CITY, FL 32405-4531
(850) 769-0325
(850) 769-4476
Mailing address
2201 JENKS AVE, PANAMA CITY, FL 32405-4531
(850) 769-0325
(850) 769-4476

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
PO1128
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO 1128
FL
213ES0131X
Foot Surgery Podiatrist
Primary
PO 1128
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
061666115
TAX ID
FL
01
45803
BLUECROSSBLUESHEIL GROUP
FL
01
480035195
RR MEDICARE
FL
01
87594
BLUECROSSBLUESHIELD OF FL
FL
01
CK8386
RR MEDICARE GROUP #
FL
Enumeration date
08/09/2006
Last updated
02/10/2014
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