Simeon H. Wall, MD a Professional Medical Corp

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

02970R Issued in LA

Legal business name

SIMEON H. WALL, MD A PROFESSIONAL MEDICAL CORP

Practice address

8600 Fern Ave
Shreveport, LA 71105-5639

Phone

(318) 795-0801

Fax

(318) 795-9492

NPI assigned

Oct 30, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Simeon Heninger Wall Sr., M.D.NPI 1700939147

Title

Owner

Phone

(318) 795-0801

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Simeon H. Wall Sr., M.D.

  • Specialist
  • Shreveport, LA
  • NPI 1700939147

  Single Specialty

  NPD (past) Authorized official

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1992059968",
    "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": {
        "organization_name": "SIMEON H. WALL, MD A PROFESSIONAL MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "SIMEON",
        "authorized_official_middle_name": "HENINGER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-795-0801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "LA",
            "license": "02970R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115649",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Silver Lining Non-Emergency Transportation LLC
• Sam Ray Silverblatt, O.D.
• Simba Ventures Hospital la, LLC
• Simba Ventures Hospital la, LLC
• Florette Sime, M.D.
• Deborah Collinsworth Simmons, M.C.D.
• Erica Nicole Simmons, MHP
• Kesha Simmons, LPC
• Laurie Crnkovic Simmons, NP
• Maggie Simmons, PLPC

• Plastic Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Plastic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.