Healthcare Provider Details

I. General information

NPI: 1588620561
Provider Name (Legal Business Name): JOHN H WALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD EMERGENCY ROOM
METAIRIE LA
70006-2970
US

IV. Provider business mailing address

PO BOX 62600 DEPT 1142
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-4196
  • Fax:
Mailing address:
  • Phone: 210-614-0180
  • Fax: 210-566-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number10286R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: