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Organization
WK RED RIVER CARDIOVASCULAR SURGEONS
Active
Organization
WK RED RIVER CARDIOVASCULAR SURGEONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
2751 ALBERT L BICKNELL DR, SUITE 5C, SHREVEPORT, LA 71103-3920
(318) 227-9777
(318) 459-1188
Mailing address
2551 GREENWOOD RD, SUITE 310, SHREVEPORT, LA 71103-3981
(318) 227-9777
(318) 459-1188
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Enumeration date
12/11/2008
Last updated
06/08/2012
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