Provider Demographics
NPI:1467633891
Name:DOTSON, DANIEL A (CPED)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:DOTSON
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 W INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1118
Mailing Address - Country:US
Mailing Address - Phone:386-252-2138
Mailing Address - Fax:386-252-0928
Practice Address - Street 1:2595 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1118
Practice Address - Country:US
Practice Address - Phone:386-252-2138
Practice Address - Fax:386-252-0928
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED 148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist