1518542182 NPI number — WHITE SANDS PODIATRY LLC

Table of content: (NPI 1518542182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518542182 NPI number — WHITE SANDS PODIATRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE SANDS PODIATRY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518542182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
981 HIGHWAY 98 E STE 3410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESTIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32541-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-622-1607
Provider Business Mailing Address Fax Number:
888-302-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1032 MAR WALT DR UNIT 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-6661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-622-1607
Provider Business Practice Location Address Fax Number:
888-302-6552
Provider Enumeration Date:
03/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HODSON
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
850-622-1607

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 472092001 . This is a "TAX ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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