Organization
VIJOYDEEP RAO MD & WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 310, SHREVEPORT, LA 71103-3981
(318) 212-8780
(318) 212-4153
Mailing address
PO BOX 3038, SHREVEPORT, LA 71133-3038
(318) 212-8780
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/06/2006
Last updated
08/22/2020
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