Organization
RAYMOND A. COGHLAN MD AND WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 150, SHREVEPORT, LA 71103-3981
(318) 631-9996
(318) 631-9345
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 631-9996
(318) 631-9345
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Enumeration date
05/09/2006
Last updated
07/28/2009
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