Individual
DR. WALLACE JEANFREAU JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3530 HOUMA BLVD, METAIRIE, LA 70006-4202
(504) 264-5142
Mailing address
3800 HOUMA BLVD, SUITE 335, METAIRIE, LA 70006-4182
(504) 779-5859
(985) 626-6995
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
015285
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1329088
—
LA
Enumeration date
09/20/2006
Last updated
01/31/2020
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