Simeon Wall JR.
Plastic and Reconstructive Surgery
8600 Fern Ave
Shreveport
, Louisiana 71105-5639
Simeon Wall JR.
Plastic and Reconstructive Surgery
8600 Fern Ave
Shreveport
, Louisiana 71105-5639
(318) 795-9492
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Simeon Wall JR.
- 8600 Fern Ave
- Shreveport, LA
- Zip : 71105-5639
- Fax : (318) 795-9492
- Phone : (318) 795-0801
Second Address
- Simeon Wall JR.
- 8600 Fern Ave
- Shreveport, LA
- Zip : 71105-5639
- Fax : (318) 795-9492
- Phone : (318) 795-0801
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | 14159R | LA |
National Provider Identifier
| NPI | 1275522682 |
|---|---|
| Provider Name | Simeon Wall JR. |
| First Address | Shreveport, LA 71105-5639 |
| Second Address | Shreveport, LA 71105-5639 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/10/2005 |
| Last Update Date | 10/04/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1184292 | (05) | LA |
| H44152 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.