NPI 1992059968

Simeon H. Wall, MD a Professional Medical Corp

Organisation Plastic Surgery Physician Shreveport, LA

Practice location

Address: 8600 Fern Ave, Shreveport, LA 71105-5639
Phone: (318) 795-0801
Fax: (318) 795-9492

Authorised official

Name: Simeon Heninger Wall
Title: Owner
Phone: (318) 795-0801

Registered specialties

Plastic Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208200000X Licence 02970R (LA)

Other Plastic Surgery providers in Louisiana →

Registry record

NPI: 1992059968
Entity type: Organization
NPI issued: 30 Oct 2012
Record last updated: 30 Oct 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.