# WK ALLERGY AND ASTHMA CLINIC

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

## Provider details

- **NPI number:** 1760939987
- **Authorized official:** GREG J GAVIN (MANAGED CARE CREDENTIALING)
- **Authorized official phone:** (318) 212-8951

## Contact information

- **Practice address:** 2300 HOSPITAL DR STE 345, BOSSIER CITY, LA 71111-2194
- **Practice address phone:** (318) 227-7946
- **Mailing address:** 2300 HOSPITAL DR, SUITE 110, BOSSIER CITY, LA 71111-2394
- **Mailing address phone:** (318) 227-7946

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | — | NULL | Yes |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2016
- **Last updated:** 04/03/2019