MEDICARE: DR. SHELLEY E DOTSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	33434	AZ
2	207Q00000X	Family Medicine Physician	40912	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184608184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY E DOTSON M.D.

Provider Business Mailing Address
First Line	:	19685 PILOT KNOB RD
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-7238
Country	:	US
Telephone Number	:	651-463-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	19685 PILOT KNOB RD
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-7238
Country	:	US
Telephone Number	:	651-463-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	09/07/2012

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