Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 15569 | NV |
NPI | 1073720678 |
---|---|
Provider Name | Dr. Jaymes D Granata |
First Address | Las Vegas, NV 89144-6645 |
Second Address | Las Vegas, NV 89144-6645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073720678 | (05) | NV |