Provider Demographics
NPI:1669473369
Name:TERRELL, WALTER LEE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:TERRELL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 VETERANS BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-833-5573
Mailing Address - Fax:504-832-9629
Practice Address - Street 1:2800 VETERANS BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-833-5573
Practice Address - Fax:504-832-9629
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-04-02
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Provider Licenses
StateLicense IDTaxonomies
LA014329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1338567Medicaid
LA1338567Medicaid
LA5M829Medicare PIN