# RAYMOND A. COGHLAN MD AND WILLIS-KNIGHTON MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003865809
- **Authorized official:** GREG J. GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-4571

## Contact information

- **Practice address:** 2551 GREENWOOD RD, SUITE 150, SHREVEPORT, LA 71103-3981
- **Practice address phone:** (318) 631-9996
- **Practice address fax:** (318) 631-9345
- **Mailing address:** 1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
- **Mailing address phone:** (318) 631-9996
- **Mailing address fax:** (318) 631-9345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 07/28/2009