Provider Demographics
NPI:1033797030
Name:WHITE SANDS PODIATRY
Entity Type:Organization
Organization Name:WHITE SANDS PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-622-1607
Mailing Address - Street 1:981 HIGHWAY 98 E STE 3410
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2584
Mailing Address - Country:US
Mailing Address - Phone:850-622-1607
Mailing Address - Fax:
Practice Address - Street 1:4012 COMMONS DR W STE 110
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8424
Practice Address - Country:US
Practice Address - Phone:850-622-1607
Practice Address - Fax:888-302-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty