Provider Demographics
NPI:1811947419
Name:JERAY, KYLE JAMES (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:JERAY
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:105 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-797-7060
Practice Address - Fax:864-797-7077
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16620207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPROVEDMedicaid
SCAPPROVEDOtherRAILROAD MEDICARE
SCAPPROVEDOtherRAILROAD MEDICARE
SCG756627951Medicare PIN
SCG75662Medicare UPIN
SC576007863085OtherBLUE CHOICE OF SC
SC166206Medicaid
SC5275722OtherAETNA
SC576007863084OtherBCBS OF SC