Individual
GRADY LYNN JETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2430 SAMARITAN DR, SAN JOSE, CA 95124-3907
(408) 559-4343
(408) 371-6387
Mailing address
2430 SAMARITAN DR, SAN JOSE, CA 95124-3907
(408) 559-4343
(408) 371-6387
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C30088
CA
Other
Enumeration date
09/02/2006
Last updated
11/04/2010
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