Healthcare Provider Details
I. General information
NPI: 1093931545
Provider Name (Legal Business Name): TORRES-HODGES, DPM, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/17/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9400 UNIVERSITY PKWY SUITE 301
PENSACOLA FL
32514-5752
US
IV. Provider business mailing address
9400 UNIVERSITY PKWY SUITE 301
PENSACOLA FL
32514-5752
US
V. Phone/Fax
- Phone: 850-478-8633
- Fax: 850-478-8579
- Phone: 850-478-8633
- Fax: 850-478-8579
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213EP1101X |
| Taxonomy | Primary Podiatric Medicine Podiatrist |
| License Number | PO 2847 |
| License Number State | FL |
VIII. Authorized Official
Name: DR.
GRACE
ELAINE
TORRES-HODGES
Title or Position: OWNER
Credential: DPM
Phone: 850-478-8633