Male or Other

Dr. Jeffrey M. Wise DO

Anesthesiology Physician in Plymouth, MN(View on Map)

Full Name

Dr. Jeffrey Mark Wise DO

NPI Number

1053871004

NPI Type

Individual Provider

Gender

Male

Enumeration Date

03/24/2019

Specialties

(Taxonomies)

Code

207L00000X

Primary Taxonomy

Yes

Licenses

State

Minnesota

License Number

73128

Contact
Information

Purpose

Mailing
Location

Address

PO BOX 47159
14700 28TH AVE N STE 20

City

Plymouth
Plymouth

State

MN
MN

Postal Code

55447-0159
55447-4876

Country

US
US

Telephone Number

(763) 559-3779
(763) 559-3779

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/08/2023

Provider Address

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