Individual
FORREST P WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
385 BERT KOUNS INDUSTRIAL LOOP STE 100, SHREVEPORT, LA 71106-8159
(318) 221-1629
(318) 221-6308
Mailing address
385 BERT KOUNS INDUSTRIAL LOOP BLDG 100, SHREVEPORT, LA 71106-8124
(318) 221-1629
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
10089R
LA
Other
Enumeration date
11/25/2005
Last updated
07/12/2021
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