John Brent Wallis MD

NPI 1023004207 - Pediatrics - 208000000X

NPI Details
NPI 1023004207
Gender Male
Enumeration Date 09/23/2005
Last Updated 12/21/2012
Entity Type Individual
Active Over 11 years ago
Practice Location
4710 S CARROLLTON AVE
NEW ORLEANS LA, 70119, US
Phone (504) 454-9020
Fax (504) 454-9031
Business Location
1000 PARK CENTRE BLVD
SUITE 100
MIAMI FL, 33169-5373, US
Phone (504) 454-9020
Fax (504) 454-9031
Toxanomy
Taxonomy Code 208000000X
License State Louisiana
License Number 025100
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According to our database, Dr. John Brent Wallis MD NPI is 1023004207, taxonomy code is 208000000X and license number is 025100, license state is located at Louisiana. John Brent Wallis MD physically located at 4710 S Carrollton Ave, New Orleans LA, 70119. NPI Number John Brent Wallis MD has the Individual type.

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1023004207 NPI number is provided on an as is basis without warranty of any kind. 1023004207 is maintained by the National Plan & Provider Enumeration System. The contents of John Brent Wallis MD are for informational purposes only.