Provider Demographics
NPI:1073720678
Name:GRANATA, JAYMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYMES
Middle Name:D
Last Name:GRANATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 BANBURRY CROSS DR STE 445
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6645
Mailing Address - Country:US
Mailing Address - Phone:702-765-0884
Mailing Address - Fax:
Practice Address - Street 1:10105 BANBURRY CROSS DR STE 445
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6645
Practice Address - Country:US
Practice Address - Phone:702-765-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15569207XX0004X
OH35.091149207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073720678Medicaid
NVV110260Medicare PIN