Basic Information
| Provider Information | |||||||||
| NPI: | 1437148798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOTSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421009 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 E COMSTOCK ST | ||||||||
| Address2: | |||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488673161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897256558 | ||||||||
| FaxNumber: | 9897256096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101013307 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4266057 | 05 | MI | MEDICAID | G56820 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 080166201/CD3610 | 01 | MA | METRAHEALTH | OTHER | 080D410020 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 080D410020 | 01 | MI | BLUE CARE NETWORK | OTHER | P61682 G03751 | 01 | MI | BCN | OTHER | 0989527 | 01 | MI | HEALTH PLUS | OTHER | 0853302505 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | C7986 | 01 | MI | MCARE | OTHER | 253069 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 253069 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 4448327 | 05 | MI | MEDICAID | 5757551 | 01 | MI | AETNA | OTHER |