Individual
DR. COURTNEY GRAY WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3850 S NATIONAL AVE STE 400, SPRINGFIELD, MO 65807-5287
(417) 269-6850
(417) 269-5830
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2019004912
MO
207V00000X
Obstetrics & Gynecology Physician
BP10040931
TX
Other
Enumeration date
06/21/2011
Last updated
02/14/2019
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