# WK NORTHWEST LOUISIANA INFECTIOUS DISEASE CONSULTANTS

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

## Provider details

- **NPI number:** 1679851893
- **Authorized official:** GREG J. GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 424-4232

## Contact information

- **Practice address:** 2551 GREENWOOD RD, SUITE 150, SHREVEPORT, LA 71103-3981
- **Practice address phone:** (318) 212-6888
- **Practice address fax:** (318) 212-6890
- **Mailing address:** 1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
- **Mailing address phone:** (318) 212-8946
- **Mailing address fax:** (318) 212-1153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2011
- **Last updated:** 10/16/2012