# WK ORTHOPEDIC CLINIC

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

## Provider details

- **NPI number:** 1780612119
- **Authorized official:** GREG J GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-4232

## Contact information

- **Practice address:** 7925 YOUREE DR, SUITE 200, SHREVEPORT, LA 71105-5127
- **Practice address phone:** (318) 212-3610
- **Practice address fax:** (318) 212-3672
- **Mailing address:** 7925 YOUREE DR, SUITE 200, SHREVEPORT, LA 71105-5127
- **Mailing address phone:** (318) 212-3610
- **Mailing address fax:** (318) 212-3672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/28/2006
- **Last updated:** 02/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1452891 | — | LA |