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General NPI Number Information
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NPI Number | 1134184476
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Entity Type | Individual
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Provider Name | JERROLD I GRAYSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 650 SANITARIUM RD
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City | DEER PARK
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State | CA
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Zip | 94576-9714
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Country | US
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Telephone | 707-963-6430
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3222
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City | NAPA
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State | CA
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Zip | 94558-0293
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Country | US
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Telephone | 707-261-7821
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Fax | 707-256-3508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G26478
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License Number State | CA
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