Individual provider · Type 1 NPI

Mallory Marie McNicholas Dotson, PA-C

Medical Physician Assistant · Portland, OR

NPI number 1114179116 Active

Practice location

10000 SE Main St, Suite 112
Portland, OR 97216-2448

Call (503) 255-3054 Map

Fax (503) 255-7651

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA01405 (OR)

Medical Physician Assistant: Definition to come...

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About NPI 1114179116

Mallory Marie McNicholas Dotson, PA-C's National Provider Identifier is 1114179116, issued on Oct 21, 2008. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Feb 25, 2025.