Provider Demographics
NPI:1861476269
Name:DOTSON, DAVID THOMAS IX (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:DOTSON
Suffix:IX
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1224 S HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1027 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4101
Practice Address - Country:US
Practice Address - Phone:918-225-2915
Practice Address - Fax:918-225-1358
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine