MEDICARE: LARKEY R DOTSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1710748082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARKEY R DOTSON PA-C

Provider Business Mailing Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-236-0508
Fax Number	:	901-682-2143

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-236-0508
Fax Number	:	901-682-2143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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