Individual
JERRY W DORRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
118 W DALLAS ST, BUFFALO, MO 65622-8669
(417) 345-6101
(417) 829-4316
Mailing address
118 W DALLAS ST, BUFFALO, MO 65622-8669
(417) 345-6101
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
148324
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421151309
—
MO
Enumeration date
09/24/2006
Last updated
10/27/2021
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