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Organization
WK ALLERGY AND ASTHMA CLINIC
Active
Organization
WK ALLERGY AND ASTHMA CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (MANAGED CARE CREDENTIALING)
(318) 212-8951
Entity
Organization
Contact information
Practice address
2300 HOSPITAL DR STE 345, BOSSIER CITY, LA 71111-2194
(318) 227-7946
Mailing address
2300 HOSPITAL DR, SUITE 110, BOSSIER CITY, LA 71111-2394
(318) 227-7946
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
Primary
—
NULL
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
Primary
—
—
Other
Enumeration date
09/06/2016
Last updated
04/03/2019
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