Organization
FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
8001 YOUREE DR, SUITE 900, SHREVEPORT, LA 71115-2302
(318) 212-3830
(318) 212-3835
Mailing address
7813 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 212-3830
(318) 212-3835
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1797031
—
LA
Enumeration date
11/04/2005
Last updated
06/08/2012
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