Provider Demographics
NPI:1124069141
Name:DOTSON, THOMAS O (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:O
Last Name:DOTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2414
Mailing Address - Country:US
Mailing Address - Phone:304-536-4870
Mailing Address - Fax:304-536-8010
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-2414
Practice Address - Country:US
Practice Address - Phone:304-536-4870
Practice Address - Fax:304-536-8010
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV8787207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000087001OtherBLUE CROSS BLUE SHIELD
WV110048103OtherRAILROAD PTAN
A72027Medicare UPIN
WV110048103OtherRAILROAD PTAN