Healthcare Provider Details

I. General information

NPI: 1689642019
Provider Name (Legal Business Name): MARK H DOTSON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WE KNIGHT DR
FORT SMITH AR
72903-6248
US

IV. Provider business mailing address

PO BOX 11230
FORT SMITH AR
72917-1230
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-6700
  • Fax: 479-709-6751
Mailing address:
  • Phone: 479-709-6700
  • Fax: 479-709-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number113
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: