SIMEON WALL JR. (NPI# 1275522682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275522682 |
| Entity Type | Individual |
| Full Name | SIMEON WALL JR. |
| Credential | MD, FACS |
| Practice Address |
8600 Fern Ave Shreveport LA 71105-5639 |
| Practice Telephone | 3187950801 |
| Practice Fax Number | 3187959492 |
| Mailing Telephone | 3187950801 |
| Mailing Fax Number | 3187959492 |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2014-04-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
14159R | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1184292 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700939147 | Simeon H. Wall Sr. | Specialist | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2007-01-19 |
| Street Address |
8600 FERN AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-5639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245229624 | Holly Casey Wall | Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2005-10-18 |
| 1992059968 | Simeon H. Wall, Md A Professional Medical Corp | Plastic Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2012-10-30 |
| 1700939147 | Simeon H. Wall Sr. | Specialist | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2007-01-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700929874 | The Plastic Surgery Center LLP | Surgery | 385 Bert Kouns Ind. Loop, Bldg 100, Shreveport, LA 71106-8124 | 2007-02-15 |
| 1912936196 | Kenneth W. Sanders, Md and Willis-knighton Medical Center | Surgery | 1811 East Bert Kouns, Suite 160, Shreveport, LA 71105-5505 | 2006-07-01 |
| 1699758474 | Forrest P Wall | Surgery | 385 Bert Kound Ind. Loop, Bldg 100, Shreveport, LA 71106-8124 | 2005-11-25 |
| 1679555072 | Stephen Jon Ramey | Surgery | 1505 E Bert Kouns Industrial Loop # 101, Shreveport, LA 71105-5723 | 2005-11-19 |
| 1245229624 | Holly Casey Wall | Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2005-10-18 |
| 1861496556 | Daniel R Knight | Surgery | 2533 Bert Kouns Industrial Loop Ste 106, Shreveport, LA 71118-3158 | 2005-06-09 |
| 1174808794 | Holly D. Casey, Md. A Professional Medical Corp. | Surgery | 8600 Fern Avenue, Shreveport, LA 71105 | 2011-10-14 |
| 1851563464 | Neurotrix, Inc. | Surgery | 1657 E 70th St, Shreveport, LA 71105-5115 | 2008-03-24 |
| 1033192828 | Mary T Kim | Surgery | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2005-11-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430257 | Thibodaux Regional Network Development Corporation | Surgery | 604 N Acadia Rd Ste 410, Thibodaux, LA 70301-4897 | 2020-06-03 |
| 1942590153 | Jenna Martin Bourgeois | Surgery | Associates In Plastic Surgery, 8425 Cumberland Place, Baton Rouge, LA 70806 | 2011-04-10 |
| 1710121306 | John P Guste | Surgery | 3900 Veterans Blvd., Suite 200, Metairie, LA 70002 | 2009-04-27 |
| 1295808863 | James W Wade | Surgery | 5233 Dijon Drive, Baton Rouge, LA 70817 | 2006-11-15 |
| 1861595969 | Terry A Cromwell | Surgery | 1101 South College Road, Suite 400, Lafayette, LA 70503 | 2006-09-06 |
| 1154344000 | Scott Keith Sullivan Jr. | Surgery | 1717 Saint Charles Ave, New Orleans, LA 70130-5223 | 2006-07-25 |
| 1568482339 | Herbert Stephen Maguire | Surgery | 501 Medical Center Dr Ste 1b, Alexandria, LA 71301-8124 | 2006-07-21 |
| 1346260205 | O'neil Joseph Engeron | Surgery | 615 Dunn St, Houma, LA 70360-4707 | 2006-07-20 |
| 1134190465 | Ralph W Colpitts | Surgery | 2000 Southwood Dr, Suite B, Lake Charles, LA 70605-4138 | 2006-01-26 |
| 1265054969 | Ford Plastic & Reconstructive Surgery Pmc | Surgery | 4864 Bluebonnet Blvd, Baton Rouge, LA 70809-9666 | 2020-05-15 |
| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.