# KIRK W COFRAN MD AND WILLIS-KNIGHTON MEDICAL CENTER

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

## Provider details

- **NPI number:** 1407896285
- **Authorized official:** GREG J GAVIN IX (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-8780

## Contact information

- **Practice address:** 2520 BERT KOUNS LOOP, SUITE 102, SHREVEPORT, LA 71118-3130
- **Practice address phone:** (318) 688-0173
- **Practice address fax:** (318) 632-5369
- **Mailing address:** 2520 BERT KOUNS LOOP, SUITE 102, SHREVEPORT, LA 71118-3130
- **Mailing address phone:** (318) 688-0173
- **Mailing address fax:** (318) 632-5369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 11/21/2007