Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 8888 | NV |
Y | 207KA0200X | Allergist | G69131 | CA |
NPI | 1205849858 |
---|---|
Provider Name | Anton Robert Dotson |
First Address | Chico, CA 95926-2175 |
Second Address | Chico, CA 95926-2175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 15/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235301805 | (05) | CA |
F51365 | (02) |