Healthcare Provider Details

I. General information

NPI: 1861476269
Provider Name (Legal Business Name): DAVID THOMAS DOTSON IX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TOM DOTSON D.O.

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 E CHERRY ST
CUSHING OK
74023-4101
US

IV. Provider business mailing address

1224 S HOLMES AVE
CUSHING OK
74023
US

V. Phone/Fax

Practice location:
  • Phone: 918-225-2915
  • Fax: 918-225-1358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2363
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: