Provider Demographics
NPI:1235152794
Name:HODOR, LAWRENCE (DPM)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:HODOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:125
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2623
Mailing Address - Country:US
Mailing Address - Phone:562-804-1381
Mailing Address - Fax:562-925-8898
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:125
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2623
Practice Address - Country:US
Practice Address - Phone:562-804-1381
Practice Address - Fax:562-925-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2949213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT19255Medicare UPIN