Provider Demographics
NPI:1336015429
Name:DOTSON PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:DOTSON PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHYSICIAN, BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-305-2301
Mailing Address - Street 1:522 W RIVERSIDE AVE STE N
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0581
Mailing Address - Country:US
Mailing Address - Phone:509-223-9020
Mailing Address - Fax:509-420-9769
Practice Address - Street 1:522 W RIVERSIDE AVE STE N
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0581
Practice Address - Country:US
Practice Address - Phone:509-223-9020
Practice Address - Fax:509-420-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty