Wall, Wendell E.
Wall, Wendell E. is an sole proprietor health care provider with primary practice located at 1801 Fairfield Avenue, Suite 200 , Shreveport LA 71101. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wall, Wendell E. can be contacted via phone (318) 675-1800.Contact Information
Primary practice address
1801 Fairfield Avenue, Suite 200
Shreveport LA 71101
Phone: (318) 675-1800
Fax: (318) 675-1818
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 11458R | Louisiana |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD.11458R | Louisiana |
Profile Details
| NPI number | 1639174105 |
|---|---|
| LBN Legal business name | Wall, Wendell E. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 20th, 2005 |
| Last updated | Oct 22nd, 2018 - about 7 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 | 1639174105 | NPPES |
| Louisiana | MEDICAID | 1663841 | |
| Louisiana | MEDICAID | 2258R |
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