Provider Demographics
NPI:1548340540
Name:PERROW, JASON WHITNEY (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WHITNEY
Last Name:PERROW
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 1:223 GLASCOCK ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604
Mailing Address - Country:US
Mailing Address - Phone:919-833-5638
Mailing Address - Fax:
Practice Address - Street 1:9331 S COLORADO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7466
Practice Address - Country:US
Practice Address - Phone:303-471-4711
Practice Address - Fax:303-471-4767
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013NAMedicaid
NC89013NAMedicaid