Individual
MR. WENDELL E. WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 FAIRFIELD AVENUE, SUITE 200, SHREVEPORT, LA 71101
(318) 675-1800
(318) 675-1818
Mailing address
1801 FAIRFIELD AVENUE, SUITE 200, SHREVEPORT, LA 71101
(318) 675-1800
(318) 675-1818
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11458R
LA
207R00000X
Internal Medicine Physician
Primary
MD.11458R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1663841
—
LA
05
—
2258R
—
TX
Enumeration date
06/20/2005
Last updated
10/22/2018
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