Provider Demographics
NPI:1437148798
Name:DOTSON, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:DOTSON
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1009
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:216 E COMSTOCK ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-3161
Practice Address - Country:US
Practice Address - Phone:989-725-6558
Practice Address - Fax:989-725-6096
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4266057Medicaid
MIG56820OtherHEALTH ALLIANCE PLAN
MA080166201/CD3610OtherMETRAHEALTH
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CARE NETWORK
MIP61682 G03751OtherBCN
MI0989527OtherHEALTH PLUS
MI0853302505OtherBLUE CROSS BLUE SHIELD
MIC7986OtherMCARE
MI253069OtherMCLAREN HEALTH PLAN
MI253069OtherHEALTH ADVANTAGE NETWORK
MI4448327Medicaid
MI5757551OtherAETNA
MI5757551OtherAETNA
MI0M28430Medicare ID - Type Unspecified
MI0989527OtherHEALTH PLUS