Individual
JACQUELINE I. DORIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4131 N 24TH ST, B-102, PHOENIX, AZ 85016-6262
(602) 955-6632
(602) 381-1341
Mailing address
2500 W UTOPIA RD, STE. 100, PHOENIX, AZ 85027-4171
(602) 214-6148
(602) 214-6149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24281
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
358946
—
AZ
Enumeration date
08/16/2005
Last updated
09/24/2013
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