MEDICARE: MR. TOMMY R DOTSON DO

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	207P00000X	Emergency Medicine Physician	R1E52	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710959994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMMY R DOTSON DO

Provider Business Mailing Address
First Line	:	32162 FISHING RIVER RD
Second Line	:
City	:	LAWSON
State	:	MO
Zip	:	64062-9643
Country	:	US
Telephone Number	:	816-630-0452
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 WOLLARD BLVD
Second Line	:
City	:	RICHMOND
State	:	MO
Zip	:	64085-2229
Country	:	US
Telephone Number	:	816-470-5432
Fax Number	:	816-470-7343

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	03/26/2015

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Directions to “ MR. TOMMY R DOTSON DO” Practice Location

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