Healthcare Provider Details

I. General information

NPI: 1790191831
Provider Name (Legal Business Name): MATTHEW DOTHAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

IV. Provider business mailing address

6451 N FEDERAL HWY STE 800
FT LAUDERDALE FL
33308-1409
US

V. Phone/Fax

Practice location:
  • Phone: 855-429-7633
  • Fax:
Mailing address:
  • Phone: 877-957-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number27656
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME131031
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-40195
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01080389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: