Individual
SIMEON WALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACS
Contact information
Practice address
8600 FERN AVE, SHREVEPORT, LA 71105-5639
(318) 795-0801
(318) 795-9492
Mailing address
8600 FERN AVE, SHREVEPORT, LA 71105-5639
(318) 795-0801
(318) 795-9492
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
14159R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184292
—
LA
Enumeration date
10/18/2005
Last updated
04/10/2014
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