Basic Information
| Provider Information | |||||||||
| NPI: | 1447254198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUNDS | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3024 NOTTINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711159530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187977538 | ||||||||
| FaxNumber: | 9048051301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 SAINT MARY PL | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186814500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 018917 | LA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110223052 | 01 | LA | RAILROAD MEDICARE | OTHER | 1968731 | 05 | LA | MEDICAID |