Organization
WK PEDIATRIC HEALTHCARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 242-4232
Entity
Organization
Contact information
Practice address
1717 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5561
(318) 212-2920
(318) 212-2910
Mailing address
1717 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5561
(318) 212-2920
(318) 212-2910
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
08/05/2011
Last updated
08/05/2011
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