=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720030471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON LANDON GARROW P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 WITZEL AVE STE A
-----------------------------------------------------
City | OSHKOSH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54904-8375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-233-1540
-----------------------------------------------------
Fax | 920-651-6951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E7376 HWY H
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54940-3454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-313-0084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 1973023
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 1973023
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------