MEDICARE: MR. DANIEL PAUL HOBGOOD IV LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA#31761	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1292	OTHER	FL	BLUE CROSS/BLUE SHIELD PROVIDER NUMBER

General Provider Information

NPI Number	:	1437482023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL PAUL HOBGOOD IV LMT

Provider Business Mailing Address
First Line	:	6420 CHAPEL ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-7013
Country	:	US
Telephone Number	:	850-313-2085
Fax Number	:	850-479-9154

Provider Business Practice Location Address
First Line	:	4317 SPANISH TRL
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4942
Country	:	US
Telephone Number	:	850-313-2085
Fax Number	:	850-479-9154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	10/08/2009

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