Provider Demographics
NPI:1710566864
Name:GARRETT, JASON RYAN (DO (MAY 2021))
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:GARRETT
Suffix:
Gender:M
Credentials:DO (MAY 2021)
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Other - Credentials:
Mailing Address - Street 1:1130 WEST MICHIGAN STREET
Mailing Address - Street 2:FESLER HALL ROOM 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5209
Mailing Address - Country:US
Mailing Address - Phone:317-274-0076
Mailing Address - Fax:317-274-0256
Practice Address - Street 1:1130 WEST MICHIGAN STREET
Practice Address - Street 2:FESLER HALL ROOM 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5209
Practice Address - Country:US
Practice Address - Phone:317-274-0076
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program