Healthcare Provider Details

I. General information

NPI: 1710959994
Provider Name (Legal Business Name): TOMMY R DOTSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 WOLLARD BLVD
RICHMOND MO
64085-2229
US

IV. Provider business mailing address

32162 FISHING RIVER RD
LAWSON MO
64062-9643
US

V. Phone/Fax

Practice location:
  • Phone: 816-470-5432
  • Fax: 816-470-7343
Mailing address:
  • Phone: 816-630-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR1E52
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: