Brown, Wallace Harold

Brown, Wallace Harold is an individual health care provider with primary practice located at 2210 Line Ave Suite 204, Shreveport LA 71104-2152. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Brown, Wallace Harold can be contacted via phone (318) 221-9671.

Contact Information

Primary practice address
2210 Line Ave Suite 204 Shreveport LA 71104-2152
Phone: (318) 221-9671
Fax: (318) 425-2343
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 011630 Louisiana

Profile Details

NPI number 1114988995
LBN Legal business name Brown, Wallace Harold
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1114988995 NPPES
Louisiana MEDICAID 1385344

Popular Providers