Organization
WK SIGNATURE UROLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 140, SHREVEPORT, LA 71103-3981
(318) 212-8899
(318) 212-8806
Mailing address
2551 GREENWOOD RD, SUITE 140, SHREVEPORT, LA 71103-3981
(318) 212-8899
(318) 212-8806
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1335223
—
LA
Enumeration date
04/19/2006
Last updated
06/08/2012
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