Individual
DR. SIMEON H. WALL SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8600 FERN AVE, SHREVEPORT, LA 71105-5639
(318) 795-0801
(318) 795-9492
Mailing address
8600 FERN AVE, SHREVEPORT, LA 71105-5639
(318) 795-0801
(318) 795-9492
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
02970R
LA
Other
Enumeration date
01/19/2007
Last updated
02/22/2012
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