Provider Demographics
NPI:1417710351
Name:PERRY, JASON (NRP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:HULETT
Mailing Address - State:WY
Mailing Address - Zip Code:82720-0341
Mailing Address - Country:US
Mailing Address - Phone:307-290-0111
Mailing Address - Fax:
Practice Address - Street 1:502 STOCKTRAIL AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3554
Practice Address - Country:US
Practice Address - Phone:307-688-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11612207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services