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NPI Code Detail

MEDICARE: DR. JAYMES D GRANATA M.D.

MEDICARE: DR. JAYMES D GRANATA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0004XOrthopaedic Foot and Ankle Surgery Physician15569NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073720678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAYMES D GRANATA M.D.
Provider Business Mailing Address
First Line : 10105 BANBURRY CROSS DR STE 445
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6645
Country : US
Telephone Number : 702-765-0884
Fax Number :
Provider Business Practice Location Address
First Line : 10105 BANBURRY CROSS DR STE 445
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6645
Country : US
Telephone Number : 702-765-0884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 03/17/2021

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