Provider Demographics
NPI:1821327057
Name:DOTSON, MICHAEL AARON (DPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AARON
Last Name:DOTSON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-8615
Mailing Address - Country:US
Mailing Address - Phone:918-688-9149
Mailing Address - Fax:918-743-5432
Practice Address - Street 1:4112 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7613
Practice Address - Country:US
Practice Address - Phone:918-743-4491
Practice Address - Fax:918-743-5432
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9065183500000X
ARPD07681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist