John Brent Wallis, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

025100 Issued in LA

Practice address

2222 Simon Bolivar Ave
New Orleans, LA 70113-1460

Phone

(504) 444-7879

NPI assigned

Sep 23, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1023004207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3838 N CAUSEWAY BLVD STE 2500",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700028315",
            "telephone_number": "504-862-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 SIMON BOLIVAR AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701131460",
            "telephone_number": "504-444-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JOHN",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "025100",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "025100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1422355",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bobby Wallace, B.A.
• Brandy S Wallace
• Jetavia Wallace
• Leslie Austin Wallace, MSW, LCSW
• Brittany Jill Wallen, PHARM.D.
• Nathaniel Ross Wallo, LCSW
• Phyllis B Wallo, MD
• Allison Grace Walls, MD
• Elisa Istre Walls, FNP-C
• Tityana Marie Walls

• Internal Medicine Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.