Individual
MR. JASON LEROY WHITMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
437 QUARTER HORSE DR, BEAR RIVER, WY 82930-9592
(307) 679-8274
Mailing address
437 QUARTER HORSE DR, BEAR RIVER, WY 82930-9592
(307) 679-8274
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/30/2020
Last updated
03/30/2020
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