IndividualActive
Jason Provus, MD
NPI 1972821320 · Orthopaedic Surgery Physician · Jackson, WY
Provider details
- NPI number
- 1972821320
- Entity type
- Individual
- Primary specialty
- Orthopaedic Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 16633A (WY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
555 E Broadway Ave Ste 129
Jackson, WY 83001-8640
Phone: (307) 733-3900
Fax: (307) 739-7683
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 428
Jackson, WY 83001-0428
Registry dates
- Enumerated
- 2010-05-10
- Last updated
- 2024-03-09
- Certified
- 2024-03-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.