Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD.203242 | LA |
N | 208000000X | Pediatrician | MD.203242 | LA |
NPI | 1124207873 |
---|---|
Provider Name | Dr. Luke Allen Wall |
First Address | New Orleans, LA 70118-5720 |
Second Address | New Orleans, LA 70118-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2007 |
Last Update Date | 24/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007528 | (05) | LA |