Basic Information
| Provider Information | |||||||||
| NPI: | 1891829016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORIS | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | BURTON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 KIRMAN AVE | ||||||||
| Address2: | (116) | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753265720 | ||||||||
| FaxNumber: | 7753281403 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 KIRMAN AVE | ||||||||
| Address2: | (116) | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753265720 | ||||||||
| FaxNumber: | 7753281403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 13592 | NV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.