1689642019 NPI number — MARK H DOTSON D.P.M.

Table of content: MARK H DOTSON D.P.M. (NPI 1689642019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689642019 NPI number — MARK H DOTSON D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOTSON
Provider First Name:
MARK
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689642019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 WE KNIGHT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-6248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-709-6700
Provider Business Practice Location Address Fax Number:
479-709-6751
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  113 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480030238 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 100780350A . This is a "OKLAHOMA MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 4350578 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 56219 . This is a "ARKANSAS BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 119098717 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8779903 . This is a "CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 904224 . This is a "USA MCO" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 15283000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 02720013 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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