Organization
THE PLASTIC SURGERY CENTER LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FORREST WALL M.D. (OWNER)
(318) 221-1629
Entity
Organization
Contact information
Practice address
385 BERT KOUNS IND. LOOP, BLDG 100, SHREVEPORT, LA 71106-8124
(318) 221-1629
Mailing address
385 BERT KOUNS IND. LOOP, BLDG 100, SHREVEPORT, LA 71106-8124
(318) 221-1629
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
02/15/2007
Last updated
10/24/2007
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