Organization
ELISE R WIESNER MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELISE R WIESNER M.D. (OWNER)
(405) 329-7066
Entity
Organization
Contact information
Practice address
900 N PORTER AVE, SUITE 310, NORMAN, OK 73071-6424
(405) 329-7066
(405) 360-6315
Mailing address
900 N PORTER AVE, SUITE 310, NORMAN, OK 73071-6424
(405) 329-7066
(405) 360-6315
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18219
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100826940A
—
OK
Enumeration date
05/24/2006
Last updated
01/22/2008
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