Individual
WESLEY MATTHEW GILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1432 KIMBROUGH RD, GERMANTOWN, TN 38138-2405
(901) 767-4499
Mailing address
1432 KIMBROUGH RD, GERMANTOWN, TN 38138-2405
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
67920
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67920
STATE LICENSE
TN
Enumeration date
05/02/2019
Last updated
07/07/2023
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