Provider Demographics
NPI:1821029687
Name:GRASSELL, JAY DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DONALD
Last Name:GRASSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-3067
Mailing Address - Country:US
Mailing Address - Phone:530-751-4784
Mailing Address - Fax:530-751-4906
Practice Address - Street 1:414 G STREET
Practice Address - Street 2:STE 210
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901
Practice Address - Country:US
Practice Address - Phone:530-741-1642
Practice Address - Fax:530-741-2056
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG063050207Q00000X
CAG63050208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G630500Medicare ID - Type Unspecified
A53718Medicare UPIN