Provider Demographics
NPI:1376753822
Name:DOTSON, SUZANNA (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNA
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041 PINES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6170
Mailing Address - Country:US
Mailing Address - Phone:954-328-3768
Mailing Address - Fax:754-209-7376
Practice Address - Street 1:10041 PINES BLVD STE A
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6170
Practice Address - Country:US
Practice Address - Phone:954-328-3768
Practice Address - Fax:754-209-7376
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17914208M00000X, 207Q00000X
OH35.136218208M00000X
FLME105311207R00000X
SC82168208M00000X, 207Q00000X
390200000X
ALMD.51746207QA0505X, 208M00000X
MEMD22493208M00000X
MIEMC0007327208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC821686Medicaid