Provider Demographics
NPI:1366490815
Name:DOSSETT, BRIAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:DOSSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1238
Mailing Address - Country:US
Mailing Address - Phone:618-283-4469
Mailing Address - Fax:618-283-4794
Practice Address - Street 1:1029 N 8TH ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1238
Practice Address - Country:US
Practice Address - Phone:618-283-4469
Practice Address - Fax:618-283-4794
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360797771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILSC5V16OtherMULTIPLAN
IL0000084555903OtherUNITED HEALTHCARE
IL128768OtherHEALTHLINK
IL34980OtherCMR/GHP
IL2600040OtherBLUE CROSS BLUE SHEILD
IL3712644700005OtherCIGNA
IL220343OtherPERSONAL CARE
IL036079777Medicaid
IL4486586OtherAETNA
IL371264470OtherGREAT WEST
IL4486586OtherAETNA
IL128768OtherHEALTHLINK
ILSC5V16OtherMULTIPLAN