Healthcare Provider Details

I. General information

NPI: 1700079506
Provider Name (Legal Business Name): MICHAEL THOMAS DOTTER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10202 SE 32ND AVE SUITE 701
MILWAUKIE OR
97222-3610
US

IV. Provider business mailing address

10202 SE 32ND AVE SUITE 701
MILWAUKIE OR
97222-3610
US

V. Phone/Fax

Practice location:
  • Phone: 503-513-2122
  • Fax: 503-513-2105
Mailing address:
  • Phone: 503-513-2122
  • Fax: 503-513-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11069
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0011069
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: