Provider Demographics
NPI:1437482023
Name:HOBGOOD, DANIEL PAUL IV (LMT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:HOBGOOD
Suffix:IV
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7013
Mailing Address - Country:US
Mailing Address - Phone:850-313-2085
Mailing Address - Fax:850-479-9154
Practice Address - Street 1:4317 SPANISH TRL
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4942
Practice Address - Country:US
Practice Address - Phone:850-313-2085
Practice Address - Fax:850-479-9154
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#31761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1292OtherBLUE CROSS/BLUE SHIELD PROVIDER NUMBER