# WK SPINE CLINIC

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

## Provider details

- **NPI number:** 1174007728
- **Authorized official:** GREG J GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-8951

## Contact information

- **Practice address:** 8001 YOUREE DR STE 450, SHREVEPORT, LA 71115-2333
- **Practice address phone:** (318) 212-3706
- **Practice address fax:** (318) 212-3846
- **Mailing address:** 8001 YOUREE DR STE 450, SHREVEPORT, LA 71115-2333
- **Mailing address phone:** (318) 212-3706
- **Mailing address fax:** (318) 212-3846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2018
- **Last updated:** 09/19/2018