Healthcare Provider Details

I. General information

NPI: 1437482023
Provider Name (Legal Business Name): DANIEL PAUL HOBGOOD IV LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 SPANISH TRL
PENSACOLA FL
32504-4942
US

IV. Provider business mailing address

6420 CHAPEL ST
PENSACOLA FL
32504-7013
US

V. Phone/Fax

Practice location:
  • Phone: 850-313-2085
  • Fax: 850-479-9154
Mailing address:
  • Phone: 850-313-2085
  • Fax: 850-479-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA#31761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: