Wallis, John Brent
Wallis, John Brent is an individual health care provider with primary practice located at 4710 S Carrollton Ave , New Orleans LA 70119. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Wallis, John Brent can be contacted via phone (504) 454-9020.Contact Information
Primary practice address
4710 S Carrollton Ave
New Orleans LA 70119
Phone: (504) 454-9020
Fax: (504) 454-9031
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 025100 | Louisiana |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 025100 | Louisiana |
Profile Details
| NPI number | 1023004207 |
|---|---|
| LBN Legal business name | Wallis, John Brent |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 23rd, 2005 |
| Last updated | Dec 21st, 2012 - about 12 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 | 1023004207 | NPPES |
| Louisiana | MEDICAID | 1422355 |
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