DR. SIMEON H. WALL SR. (NPI# 1700939147) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700939147 |
| Entity Type | Individual |
| Full Name | DR. SIMEON H. WALL SR. |
| Credential | M.D. |
| 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 | 2007-01-19 |
| Last Update Date | 2012-02-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 02970R | LA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275522682 | Simeon Wall Jr. | Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2005-10-18 |
| 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 |
| 1275522682 | Simeon Wall Jr. | Surgery | 8600 Fern Ave, Shreveport, LA 71105-5639 | 2005-10-18 |
| 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 | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346879335 | Donesa Walker | Specialist | 8856 Youree Dr Ste D, Shreveport, LA 71115-2514 | 2020-04-02 |
| 1447749304 | Kelly E Rachal, Dvm | Specialist | 4445 Youree Dr, Shreveport, LA 71105-3618 | 2018-05-07 |
| 1407381973 | Dominique Stevenson | Specialist | 6800 Rasberry Lane Apt.1901, Shreveport, LA 71129 | 2017-04-21 |
| 1063816304 | Lisa Dupree | Specialist | 7655 Grimm Rd, Shreveport, LA 71107-3450 | 2014-10-15 |
| 1205256633 | Rhydonia R. Pillars | Specialist | 3110 Bert Kouns Industrial Loop # 11, Ste G, Shreveport, LA 71118-2948 | 2014-04-24 |
| 1912253618 | A Golden Touch Inc | Specialist | 3110 Bert Kouns Industrial Loop Ste G, Box 11, Shreveport, LA 71118 | 2012-07-31 |
| 1396048385 | Thomas J. Worgul, M.d., Apmc | Specialist | 7837 Youree Dr, Shreveport, LA 71105-5505 | 2010-12-13 |
| 1083929954 | Henock G Zabher LLC | Specialist | 8007 Amy Hewes Dr, Shreveport, LA 71115-4605 | 2010-08-16 |
| 1881907624 | Katharine Marie Meldrum | Specialist | 6602 Gilbert Dr, Shreveport, LA 71106-2300 | 2010-07-21 |
| 1033352976 | Jennifer A Perfetto | Specialist | 9809 Hearthside Cir, Shreveport, LA 71118-4830 | 2009-04-08 |
| Find all providers in SHREVEPORT | ||||
| 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.