Provider Demographics
NPI:1720030471
Name:GARROW, JASON LANDON (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LANDON
Last Name:GARROW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E7376 HWY H
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-3454
Mailing Address - Country:US
Mailing Address - Phone:920-313-0084
Mailing Address - Fax:
Practice Address - Street 1:E7376 HWY H
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:WI
Practice Address - Zip Code:54940-3454
Practice Address - Country:US
Practice Address - Phone:920-313-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1973023363AS0400X
WI1973-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty