=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366490815
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN W. DOSSETT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1029 N 8TH ST
-----------------------------------------------------
City | VANDALIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62471-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-283-4469
-----------------------------------------------------
Fax | 618-283-4794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1029 N 8TH ST
-----------------------------------------------------
City | VANDALIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62471-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-283-4469
-----------------------------------------------------
Fax | 618-283-4794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0360797771
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------