Individual
DR. JASON D PROVUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 E BROADWAY AVE STE 129, JACKSON, WY 83001-8640
(307) 733-3900
(307) 739-7683
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 733-3900
(307) 739-7683
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
16633A
WY
Other
Enumeration date
05/10/2010
Last updated
03/09/2024
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