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Organization
WK ORTHOPEDIC SPECIALTY CENTER
Active
Organization
WK ORTHOPEDIC SPECIALTY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINSTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD STE 130, SHREVEPORT, LA 71103-3984
(318) 212-8681
(318) 212-8685
Mailing address
2551 GREENWOOD RD STE 130, SHREVEPORT, LA 71103-3984
(318) 212-8681
(318) 212-8685
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2169939
—
LA
Enumeration date
05/25/2011
Last updated
06/08/2012
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