MEDICARE: MARK H DOTSON D.P.M.

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	213E00000X	Podiatrist	113	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480030238	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4350578	OTHER	AR	AETNA
4	56219	OTHER	AR	ARKANSAS BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8779903	OTHER	AR	CIGNA
7	904224	OTHER	AR	USA MCO
8	15283000000	OTHER	AR	QUALCHOICE
9	02720013	OTHER	AR	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1689642019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK H DOTSON D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 11230
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-1230
Country	:	US
Telephone Number	:	479-709-6700
Fax Number	:	479-709-6751

Provider Business Practice Location Address
First Line	:	3501 WE KNIGHT DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6248
Country	:	US
Telephone Number	:	479-709-6700
Fax Number	:	479-709-6751

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	12/14/2009

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Directions to “ MARK H DOTSON D.P.M.” Practice Location

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