Healthcare Provider Details

I. General information

NPI: 1124069141
Provider Name (Legal Business Name): THOMAS O DOTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2414
US

IV. Provider business mailing address

320 W MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2414
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-4870
  • Fax: 304-536-8010
Mailing address:
  • Phone: 304-536-4870
  • Fax: 304-536-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8787
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: