Provider Demographics
NPI:1114217502
Name:DORY, MEGAN JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JEAN
Last Name:DORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:JEAN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:645 N ARLINGTON AVE
Mailing Address - Street 2:STE 620
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-329-2525
Mailing Address - Fax:775-348-0740
Practice Address - Street 1:645 N ARLINGTON AVE STE 620
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4444
Practice Address - Country:US
Practice Address - Phone:775-329-2525
Practice Address - Fax:775-348-0740
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD167058208000000X
390200000X
NV163072080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500654512Medicaid