Organization
WK SOUTH OB-GYN CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2508 BERT KOUNS INDUSTRIAL LOOP, SUITE 305, SHREVEPORT, LA 71118-3133
(318) 688-5316
(318) 688-5318
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 688-5316
(318) 688-5318
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
02/05/2007
Last updated
06/08/2012
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