Provider Demographics
NPI:1689642019
Name:DOTSON, MARK H (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:DOTSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11230
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1230
Mailing Address - Country:US
Mailing Address - Phone:479-709-6700
Mailing Address - Fax:479-709-6751
Practice Address - Street 1:3501 WE KNIGHT DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6248
Practice Address - Country:US
Practice Address - Phone:479-709-6700
Practice Address - Fax:479-709-6751
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR113213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR480030238OtherRAILROAD MEDICARE
OK100780350AOtherOKLAHOMA MEDICAID
AR4350578OtherAETNA
AR56219OtherARKANSAS BLUE CROSS
AR119098717Medicaid
AR8779903OtherCIGNA
AR904224OtherUSA MCO
AR15283000000OtherQUALCHOICE
AR02720013OtherUNITED HEALTHCARE
AR904224OtherUSA MCO
AR15283000000OtherQUALCHOICE