Provider Demographics
NPI:1558391367
Name:DORRIS, JASON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:DORRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W SAINT LOUIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2047
Mailing Address - Country:US
Mailing Address - Phone:618-932-2200
Mailing Address - Fax:618-932-2202
Practice Address - Street 1:309 W SAINT LOUIS ST STE B
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2047
Practice Address - Country:US
Practice Address - Phone:618-932-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical