Provider Demographics
NPI:1184608184
Name:DOTSON, SHELLEY E (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:E
Last Name:DOTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19685 PILOT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7238
Mailing Address - Country:US
Mailing Address - Phone:651-463-5100
Mailing Address - Fax:
Practice Address - Street 1:19685 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7238
Practice Address - Country:US
Practice Address - Phone:651-463-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33434207Q00000X
MN40912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ915374Medicaid
G84786Medicare UPIN
AZ103693Medicare PIN