Grayson, Jerrold I
Grayson, Jerrold I is an individual health care provider with primary practice located at 650 Sanitarium Rd , Deer Park CA 94576-9714. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Grayson, Jerrold I can be contacted via phone (707) 963-6430.Contact Information
Primary practice address
650 Sanitarium Rd
Deer Park CA 94576-9714
Phone: (707) 963-6430
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | G26478 | California |
Profile Details
| NPI number | 1134184476 |
|---|---|
| LBN Legal business name | Grayson, Jerrold I |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 19th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134184476 | NPPES |
| California | MEDICAID | 00G264780 |
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