Individual
DR. JOHN BRENT WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2222 SIMON BOLIVAR AVE, NEW ORLEANS, LA 70113-1460
(504) 444-7879
Mailing address
3838 N CAUSEWAY BLVD STE 2500, METAIRIE, LA 70002-8315
(504) 862-7615
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025100
LA
208000000X
Pediatrics Physician
025100
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1422355
—
LA
Enumeration date
09/23/2005
Last updated
09/24/2025
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