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Individual

DR. JERRY WADE GRISE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2405 SNOWBERRY CIR, COLUMBIA, MO 65201-3576
(573) 442-0003
Mailing address
1661 INTERNATIONAL PLACE DRIVE, SUITE 350, MEMPHIS, TN 38120
(901) 685-2696

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2933
TN

Other

Enumeration date
10/29/2010
Last updated
10/29/2010
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