Brown, Wallace Harold
Brown, Wallace Harold is an individual health care provider with primary practice located at 2210 Line Ave Suite 204, Shreveport LA 71104-2152. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Brown, Wallace Harold can be contacted via phone (318) 221-9671.Contact Information
Primary practice address
2210 Line Ave Suite 204
Shreveport LA 71104-2152
Phone: (318) 221-9671
Fax: (318) 425-2343
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Plastic Surgery | 208200000X | 011630 | Louisiana |
Profile Details
| NPI number | 1114988995 |
|---|---|
| LBN Legal business name | Brown, Wallace Harold |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 31st, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114988995 | NPPES |
| Louisiana | MEDICAID | 1385344 |
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