Individual
JOHN PETER VALIULIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF SURGERY, PLASTICS, SHREVEPORT, LA 71103-4228
(318) 813-2655
(318) 813-2673
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
03244R
LA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
03244R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1123421
—
LA
01
—
55656F600
MEDICARE - PTAN
LA
Enumeration date
07/25/2006
Last updated
03/13/2014
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