Organization
WK AND BONE & JOINT CLINIC - BOSSIER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8701
Entity
Organization
Contact information
Practice address
2449 HOSPITAL DR, SUITE 200, BOSSIER CITY, LA 71111-2399
(318) 425-8701
(318) 424-0376
Mailing address
2449 HOSPITAL DR, SUITE 200, BOSSIER CITY, LA 71111-2382
(318) 425-8701
(318) 424-0376
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14924851
—
LA
01
—
614325700
US DEPT OF LABOR
—
Enumeration date
05/15/2006
Last updated
06/08/2012
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