Organization
WK TOTS TO TEENS PEDIATRIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
845 OLIVE ST, SUITE A, SHREVEPORT, LA 71104-2141
(318) 226-4892
(318) 227-4927
Mailing address
845 OLIVE ST, SUITE A, SHREVEPORT, LA 71104-2141
(318) 226-4892
(318) 227-4927
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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