Provider Demographics
NPI:1689612616
Name:TORRES-HODGES, GRACE ELAINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ELAINE
Last Name:TORRES-HODGES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5752
Mailing Address - Country:US
Mailing Address - Phone:850-478-8633
Mailing Address - Fax:850-478-8579
Practice Address - Street 1:9400 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5752
Practice Address - Country:US
Practice Address - Phone:850-478-8633
Practice Address - Fax:850-478-8579
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2847213EP1101X, 213ES0103X
AL240213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65655OtherBLUE CROSS BLUE SHIELD FL
FL519122001OtherMEDICARE DME SUPPLIER #
AL240OtherALABAMA LICENSE NUMBER
FLPO 2847OtherFLORIDA LICENSE NUMBER
FLPO 2847OtherFLORIDA LICENSE NUMBER
FLU80215Medicare UPIN
FL65655YMedicare ID - Type UnspecifiedMEDICARE NUMBER