Organization
WK PEDIATRIC HEALTH & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8951
Entity
Organization
Contact information
Practice address
909 OLIVE ST, SHREVEPORT, LA 71104-2103
(318) 698-3291
(318) 698-3293
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/20/2019
Last updated
06/20/2019
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