Simeon H. Wall Sr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

02970R Issued in LA

Practice address

8600 Fern Ave
Shreveport, LA 71105-5639

Phone

(318) 795-0801

Fax

(318) 795-9492

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 29, 2016 through Sep 29, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Simeon H. Wall, MD a Professional Medical Corp

  • Plastic Surgery Physician
  • Shreveport, LA
  • NPI 1992059968

  Single Specialty

  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329868800000",
    "number": "1700939147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 FERN AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055639",
            "telephone_number": "318-795-0801",
            "fax_number": "318-795-9492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 FERN AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055639",
            "telephone_number": "318-795-0801",
            "fax_number": "318-795-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SIMEON",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "02970R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyreunte Walker
• April Wilson Wall, DPT
• Forrest P Wall, M.D.
• Holly Casey Wall, MD, FACS
• Simeon Wall Jr., MD, FACS
• Wendell E. Wall, M.D.
• Aleric Wallace
• Ariante Vanae Wallace
• Casandra Wallace, M.S.
• Darre'LL J Wallace

• Specialist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.