Provider Demographics
NPI:1194071092
Name:DOTSON, MARIE IRENE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:IRENE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:HONEY GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:75446-0103
Mailing Address - Country:US
Mailing Address - Phone:903-378-3082
Mailing Address - Fax:903-378-3082
Practice Address - Street 1:1106 15TH ST
Practice Address - Street 2:#24
Practice Address - City:HONEY GROVE
Practice Address - State:TX
Practice Address - Zip Code:75446-2070
Practice Address - Country:US
Practice Address - Phone:903-486-5997
Practice Address - Fax:903-337-8308
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22543297172A00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)