# WK VASCULAR SURGICAL ASSOCIATES

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

## Provider details

- **NPI number:** 1598096240
- **Authorized official:** GREG J GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-4232

## Contact information

- **Practice address:** 2751 ALBERT L BICKNELL DR, SUITE 5A, SHREVEPORT, LA 71103-3920
- **Practice address phone:** (318) 226-0058
- **Practice address fax:** (318) 226-1759
- **Mailing address:** 2751 ALBERT L BICKNELL DR, SUITE 5A, SHREVEPORT, LA 71103-3920
- **Mailing address phone:** (318) 226-0058
- **Mailing address fax:** (318) 226-1759

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/20/2010
- **Last updated:** 06/08/2012