Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD167058 | OR |
Y | 2080A0000X | Adolescent Medicine | 16307 | NV |
NPI | 1114217502 |
---|---|
Provider Name | Mrs. Megan Jean Dory |
First Address | Reno, NV 89503 |
Second Address | Reno, NV 89503-4444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500654512 | (05) | OR |