Active NPI
Grady Lynn Jeter, M.D.
- Specialist
- San Jose, CA
National Provider Identifier
1760584510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- C30088
- Practice address
- 2430 Samaritan Dr
San Jose, CA 95124-3907 - Phone
- (408) 559-4343
- Fax
- (408) 371-6387
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | C30088 | CA | Primary |
Addresses
Primary practice location
2430 Samaritan Dr
San Jose, CA 95124-3907
Mailing address
2430 Samaritan Dr
San Jose, CA 95124-3907
Phone (408) 559-4343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C30088 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288828800000",
"number": "1760584510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2430 SAMARITAN DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951243907",
"telephone_number": "408-559-4343",
"fax_number": "408-371-6387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2430 SAMARITAN DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951243907",
"telephone_number": "408-559-4343",
"fax_number": "408-371-6387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JETER",
"first_name": "GRADY",
"middle_name": "LYNN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2010-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "C30088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.