Individual
DR. WALLACE HAROLD BROWN II
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2210 LINE AVE, SUITE 204, SHREVEPORT, LA 71104-2152
(318) 221-9671
(318) 425-2343
Mailing address
2210 LINE AVE, SUITE 204, SHREVEPORT, LA 71104-2152
(318) 221-9671
(318) 425-2343
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
011630
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1385344
—
LA
Enumeration date
03/31/2006
Last updated
07/08/2007
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