Individual
DOUGLAS DOTHAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4600 MEMORIAL DR STE 200, BELLEVILLE, IL 62226-5363
(618) 233-2220
(618) 233-2555
Mailing address
4600 MEMORIAL DR, STE. 120, BELLEVILLE, IL 62226-5368
(618) 233-2220
(618) 233-2555
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036091795
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091795
—
IL
Enumeration date
06/24/2005
Last updated
03/03/2021
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