Individual
DR. JEFFREY GRANT WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1415 TULANE AVE, NEW ORLEANS, LA 70112-2600
(504) 988-2300
(504) 988-7691
Mailing address
1430 TULANE AVE, TW22, NEW ORLEANS, LA 70112-2632
(504) 988-2300
(504) 988-7691
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13583R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1432113
—
LA
Enumeration date
10/04/2006
Last updated
01/24/2011
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