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Organization
WK BOSSIER OB-GYN
Active
Organization
WK BOSSIER OB-GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
2449 HOSPITAL DR, SUITE 260, BOSSIER CITY, LA 71111-2399
(318) 212-7840
(318) 212-7845
Mailing address
2449 HOSPITAL DR, SUITE 260, BOSSIER CITY, LA 71111-2399
(318) 212-7840
(318) 212-7845
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452874
—
LA
Enumeration date
06/11/2006
Last updated
06/08/2012
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