OrganizationActive
Simeon H. Wall, MD a Professional Medical Corp
NPI 1992059968 · Plastic Surgery Physician · Shreveport, LA
Provider details
- NPI number
- 1992059968
- Entity type
- Organization
- Primary specialty
- Plastic Surgery PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Simeon Wall, Owner
- License
- 02970R (LA)
Practice location
8600 Fern Ave
Shreveport, LA 71105-5639
Phone: (318) 795-0801
Fax: (318) 795-9492
Mailing address
8600 Fern Ave
Shreveport, LA 71105-5639
Registry dates
- Enumerated
- 2012-10-30
- Last updated
- 2012-10-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.