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NPI Code Detail

MEDICARE: JALIEN KATRICE DORRIS DO

MEDICARE: JALIEN KATRICE DORRIS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDO175353OR

General Provider Information

NPI Number : 1497985931
Entity Type Code : Individual
Provider Name (Legal Business Name) : JALIEN KATRICE DORRIS DO
Provider Business Mailing Address
First Line : 444 NW ELKS DR
Second Line :
City : CORVALLIS
State : OR
Zip : 97330-3745
Country : US
Telephone Number : 541-754-1150
Fax Number :
Provider Business Practice Location Address
First Line : 633 N ALBANY RD NW
Second Line :
City : ALBANY
State : OR
Zip : 97321-1433
Country : US
Telephone Number : 541-926-3441
Fax Number : 844-427-6168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2009
Last Update Date : 06/03/2021

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