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Individual

THOMAS A WALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSPT

Contact information

Practice address
1616 S COLUMBIA ST, STE B, BOGALUSA, LA 70427-5880
(985) 735-3080
(985) 735-7031
Mailing address
1616 S COLUMBIA ST, STE B, BOGALUSA, LA 70427-5880
(985) 735-3080
(985) 735-7031

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1471640
LA
Enumeration date
04/02/2007
Last updated
07/08/2007
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