Provider Demographics
NPI:1366458366
Name:JANES, MARK ELLIOT (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ELLIOT
Last Name:JANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E LIBERTY ST
Mailing Address - Street 2:STE 555
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2104
Mailing Address - Country:US
Mailing Address - Phone:775-883-2202
Mailing Address - Fax:775-883-0797
Practice Address - Street 1:313 WEST ANN STREET
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-883-2202
Practice Address - Fax:775-883-0797
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10244207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
430000219OtherRAILROAD MEDI
NV2413300Medicaid
H33394Medicare UPIN
518469589Medicare ID - Type Unspecified