MEDICARE: DOUGLAS DOTHAGER MD

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	207RP1001X	Pulmonary Disease Physician	036091795	IL

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	:	1871599738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS DOTHAGER MD

Provider Business Mailing Address
First Line	:	4600 MEMORIAL DR
Second Line	:	STE. 120
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5368
Country	:	US
Telephone Number	:	618-233-2220
Fax Number	:	618-233-2555

Provider Business Practice Location Address
First Line	:	4600 MEMORIAL DR STE 200
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5363
Country	:	US
Telephone Number	:	618-233-2220
Fax Number	:	618-233-2555

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/03/2021

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