Healthcare Provider Details

I. General information

NPI: 1255367645
Provider Name (Legal Business Name): RANDALL JAMES DOTTS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2555
US

IV. Provider business mailing address

1641 PINEWOOD DR
ORLANDO FL
32804-3437
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-4911
  • Fax:
Mailing address:
  • Phone: 407-293-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 1823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: