Provider Demographics
NPI:1235962028
Name:WHITE SANDS PODIATRY LLC
Entity type:Organization
Organization Name:WHITE SANDS PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-622-1607
Mailing Address - Street 1:981 US HWY 98
Mailing Address - Street 2:STE 3410
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541
Mailing Address - Country:US
Mailing Address - Phone:850-622-1607
Mailing Address - Fax:888-302-6552
Practice Address - Street 1:1032 MAR WALT DR
Practice Address - Street 2:STE 100
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-622-1607
Practice Address - Fax:888-302-6552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE SANDS PODIATRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty