Provider Demographics
NPI:1255564076
Name:TONY W DOTSON, DO, PLLC
Entity type:Organization
Organization Name:TONY W DOTSON, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-325-6888
Mailing Address - Street 1:617 23RD ST STE 415
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2882
Mailing Address - Country:US
Mailing Address - Phone:606-325-6888
Mailing Address - Fax:606-326-9368
Practice Address - Street 1:617 23RD ST STE 415
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-325-6888
Practice Address - Fax:606-326-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0974603OtherMEDICARE ID-TYPE UNSPECIFIED
KY64035538Medicaid
KY0974603OtherMEDICARE ID-TYPE UNSPECIFIED