Healthcare Provider Details

I. General information

NPI: 1366458366
Provider Name (Legal Business Name): MARK ELLIOT JANES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 WEST ANN STREET
CARSON CITY NV
89703
US

IV. Provider business mailing address

1 E LIBERTY ST STE 555
RENO NV
89501-2104
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-2202
  • Fax: 775-883-0797
Mailing address:
  • Phone: 775-883-2202
  • Fax: 775-883-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10244
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: