Organization
WALLS MEDICINE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WENDELL E. WALL M.D. (OWNER)
(318) 675-1800
Entity
Organization
Contact information
Practice address
1801 FAIRFIELD AVE. STE 200, SHREVEPORT, LA 71101
(318) 675-1800
(318) 675-1818
Mailing address
1801 FAIRFIELD AVE. STE 200, SHREVEPORT, LA 71101
(318) 675-1800
(318) 675-1818
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11458R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1663841
—
LA
Enumeration date
11/29/2007
Last updated
11/09/2018
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